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Recurrence and pain three years after groin hernia repair: Validation of postal questionnaire and selective physical examination as a method of follow-up
Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
Motala Hospital, Motala, Sweden.
2002 (English)In: European Journal of Surgery, ISSN 1102-4151, Vol. 168, no 1, 22-28 p.Article in journal (Refereed) Published
Abstract [en]


To evaluate recurrence rate and chronic groin pain three years after hernia repair and to validate a postal questionnaire with selective physical examination as a method of follow-up.


Prospective cohort study.


County hospital, Sweden.


Prospective data were retrieved from the Swedish Hernia Register for patients aged 15–80 years at the time of groin hernia repair, operated on during 1994.


Three years after operation patients were mailed a three-item questionnaire and invited to have a physical examination. Those examined answered a detailed questionnaire about pain and functional impairment. When appropriate an extended physical examination was undertaken to find out the probable cause of the pain.

Main outcome measures:

Recurrence, pain, and functional impairment.


272 hernias were repaired in 264 patients. 24 patients had died and 16 had a recurrence before the follow-up examination. After a median observation time of 44 months, 218 patients with 223 repairs (96%) were examined. Depending on the definition of recurrence and completeness of physical examination (selective or all patients) the recurrence rate varied between 10% (25/239) and 15% (35/239) including recurrences diagnosed before follow-up. 40 patients (18%) reported groin pain at follow-up, which was considered to be caused by a previous hernia repair in 34 (15%), 12 of whom (5%) had moderate or severe pain. Postoperative complications were associated with an increased risk of chronic pain, whereas type of hernia and use of mesh had no influence.


The incidence of recurrence and chronic pain after hernia repair requires continuous audit in non-specialised units. Participation in a register and follow-up by a three-item questionnaire and selective physical examination provides a solid basis for quality control.

Place, publisher, year, edition, pages
2002. Vol. 168, no 1, 22-28 p.
Keyword [en]
Follow-up, Functional impairment, Groin hernia, Pain, Questionnaire, Recurrence
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-47036DOI: 10.1080/110241502317307535OAI: diva2:267932
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2012-09-10Bibliographically approved
In thesis
1. Quality assessment in groin hernia surgery: the role of a register
Open this publication in new window or tab >>Quality assessment in groin hernia surgery: the role of a register
2001 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Ever since the Romans 2000 years ago the management of hernia surgery has remained a challenge to surgeons. Modern groin hernia treatment started with the Italian, Eduardo Bassini, around 1890 when he presented his method of repair. The most important innovations after Bassini are the Shouldice repair and introduction of prosthetic materials.

The last century has witnessed a continuous gap between, on the one hand excellent results repmted from dedicated hernia centres, and on the other outcome following hernia surgery in general surgical practice, in Sweden and elsewhere. One obstacle to quality assessment is the magnitude of hernia surgery. It is the most commonly performed procedure in Swedish general surgical practice with an incidence of around 17,000 to 20,000 repairs annually.

In 1992 a national quality register for hernia surgery was started, the Swedish Hernia Register (SHR). The general aim of this thesis is to study to what extent a quality register can be used for describing and analysing hernia surgery and can serve as a tool in the improvement process in non-specialised hospitals. Prospectively registered data in the SHR from 1992 to 1998 are the source of information for the six papers included.

The number of units participating in the SHR has increased from eight in 1992 to 65 in 2001, covering approximately 80% of units performing hernia surgery in Sweden. In January 2001 the database comprised almost 50,000 hernia repairs. Coverage of hernia operations in the SHR among participating units was high, 98%. Register participation, per se, improved the outcome of hernia surgery at aligned units during the early phase of the SHR.

In the studies forming the basis of this thesis we found that the use of mesh increased from 6 to 61% from 1992 to 1996-1998 and that the cumulative incidence of reoperation for recurrence decreased significantly during the same period. Recurrent hernia, absorbable suture, direct hernia and postoperative complication were identified as factors carrying an enhanced risk for reoperation.

SHR data show that femoral hernia is more common in females and associated with an enhanced risk for emergency operation. Mortality within 30 days of surgery, for men, was lower than that of the background population after elective inguinal hernia repair but increased after emergency operations, especially if bowel resection was undertaken.

Recurrent groin hernia still constitutes a significant quantitative problem for the surgical community, 15% of all repairs registered in 1996-1998 being repairs for recurrence. Anterior mesh repair according to Lichtenstein and laparoscopic methods were associated with a lower risk for reoperation following recurrent hernia repair.

In one hospital cohort from 1994, the recurrence rate was 10.5-14.6% 44 months after surgery, exceeding the reoperation rate by 1.7-2.3 times depending on definition of recurrence and method of follow-up. Fifteen per cent of patients in this cohort had pain related to previous hernia surgery, pain intensity being moderate or severe in 5 % of all patients followed-up.

The SHR, with reoperation as its main endpoint, may be used to describe and analyse hernia surgery and to stimulate local improvement. It has to be supplemented by questionnaire and/or physical examination in order to estimate rates of recurrence and chronic pain.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2001. 83 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 685
National Category
Medical and Health Sciences
urn:nbn:se:liu:diva-25653 (URN)10029 (Local ID)91-7219-974-1 (ISBN)10029 (Archive number)10029 (OAI)
Public defence
2001-09-21, Berzeliussalen, Universitetssjukhuset, Linköping, 09:00 (Swedish)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-10Bibliographically approved

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