Surgical Technique and Chronic Postoperative Inguinal Pain in Patients Undergoing Open Inguinal Hernioplasty in Portugal: A Prospective Multicentric Cohort Study


  • Irène Santos Faculdade de Medicina. Universidade do Porto. Porto. .
  • Joana F. F. Simões Hospital Garcia de Orta. Unidade Local de Saúde de Almada-Seixal. Almada.
  • Cláudia Camila Dias Faculdade de Medicina. Universidade do Porto. Porto.
  • Mafalda Sampaio Alves Faculdade de Medicina. Universidade do Porto. Porto.
  • José Azevedo Fundação Champalimaud. Lisboa.
  • Miguel Cunha Unidade Local de Saúde do Algarve. Portimão.
  • Ana Alagoa João Fundação Champalimaud. Lisboa.
  • José Guilherme Nobre Hospital Garcia de Orta. Unidade Local de Saúde de Almada-Seixal. Almada.
  • Maria Picciochi Hospital Professor Doutor Fernando Fonseca. Unidade Local de Saúde de Amadora/Sintra. Amadora.
  • António Sampaio Soares Hospital Professor Doutor Fernando Fonseca. Unidade Local de Saúde de Amadora/Sintra. Amadora.
  • Bárbara Vieira Hospital de Santo Espírito da Ilha Terceira. Ilha Terceira.
  • Mariana Peyroteo Instituto Português de Oncologia do Porto Francisco Gentil. Porto.
  • on behalf of PT Surg



Chronic Pain/etiology, Hernia, Inguinal/surgery, Herniorrhaphy/methods, Pain, Postoperative, Portugal


Introduction: Evidence about the advantage of Lichtenstein’s repair, the guidelines’ recommended technique, is scarce regarding postoperative chronic inguinal pain (CPIP). The primary aim of this study was to compare CPIP in patients undergoing Lichtenstein versus other techniques.
Methods: Prospective multicentric cohort study including consecutive adults undergoing elective inguinal hernia repair in Portuguese hospitals (October - December 2019). Laparoscopic and mesh-free hernia repairs were excluded. The primary outcome was postoperative pain at three months, defined as a score of ≥ 3/10 in the European Hernia Society Quality of Life score pain domain. The secondary outcome was 30-day postoperative complications.
Results: Eight hundred and sixty-nine patients from 33 hospitals were included. Most were men (90.4%) and had unilateral hernias (88.6%). Overall, 53.6% (466/869) underwent Lichtenstein’s repair, and 46.4% (403/869) were treated with other techniques, of which 83.9% (338/403) were plug and patch. The overall rate of CPIP was 16.6% and 12.2% of patients had surgical complications. The unadjusted risk was similar for CPIP (OR 0.76, p = 0.166, CI 0.51 - 1.12) and postoperative complications (OR 1.06, p = 0.801, CI 0.69 - 1.60) between Lichtenstein and other techniques. After adjustment, the risk was also similar for CPIP (OR 0.83, p = 0.455, CI 0.51 - 1.34) and postoperative complications (OR 1.14, p = 0.584, CI 0.71 - 1.84).
Conclusion: The Lichtenstein technique was not associated with lower CPIP and showed comparable surgical complications. Further investigation as- sessing long term outcomes is necessary to fully assess the benefits of the Lichtenstein technique regarding CPIP.


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How to Cite

Santos I, F. F. Simões J, Dias CC, Sampaio Alves M, Azevedo J, Cunha M, Alagoa João A, Nobre JG, Picciochi M, Sampaio Soares A, Vieira B, Peyroteo M, on behalf of PT Surg. Surgical Technique and Chronic Postoperative Inguinal Pain in Patients Undergoing Open Inguinal Hernioplasty in Portugal: A Prospective Multicentric Cohort Study. Acta Med Port [Internet]. 2024 Jul. 1 [cited 2024 Jul. 25];37(7-8):507-1. Available from: