Quality of life in patients after laparoscopic hernioplasty: recurrence of the disease and chronic pain syndrome

Background. One of the main factors that reduce the quality of life in patients after surgery for inguinal hernias is the recurrence of the disease and the development of chronic pain syndrome.Material and methods. The results of surgical treatment of 1897 patients with inguinal hernias who underwent laparoscopic hernioplasty using the TAPP method were analyzed. The aim of the study is to determine the relationship between the type and size of the mesh, as well as the technical features of surgical intervention, with the probability of developing chronic pain syndrome and recurrent inguinal hernia. Group 1 - 842 patients who underwent TAPP using the ProGrip ™ self-fixing mesh, group 2 - 1054 patients operated using the TAPP method using the vypro II light composite mesh.Results. In group 1, relapse occurred in 1 out of 842 patients (0.12%) when using a mesh area of less than 120 cm2, in group 2 (control), relapses were observed in 7 out of 1054 patients (0.66%), while even a relatively large mesh size (more than 140 cm2) did not always guarantee the absence ofrecurrence. Thecause of recurrence is a shift of the lower edge of the mesh up, migration of its medial or lateral edge into the newly formed hernial canal due to insufficient size or fixation. Chronic pain syndrome was detected in 1 patient of the main group, whereas in the control group of such patients there were 13 for 1054 observations. The causes of this complication are directly related to the method of fixing the mesh: direct contact of a metal brace with a nerve twig or the development of a single-tissue scar in the area of the intracorporeal suture or a fixing element.Conclusions. A self-fixing implant of sufficient size (10x15 cm), which provides “sticking” of the mesh over the entire surface, reliably protects the patient from both the development of chronic pain syndrome and recurrence of the disease.