Editorial
Going through the article titled “chronic groin pain following Lichtenstein mesh hernioplasty for inguinal hernia. Is it a myth?”, was a treat to read that such an important aspect of a routine surgery has been addressed to, which usually is forgotten in this very common surgical procedure.
It is good to see such an astonishing amount of cases being performed i.e. 470 cases which almost reaches to two cases per day considering only <300 working days a year in Indian scenario which is land of festivals.
We wanted to clarify that in the material and methods it has been mentioned that patients were followed up at 3 months, 6 month, 1 year and 2 year after surgery. Since the study period was from 01 Feb. 2006 to 29 Feb. 2008 which constitutes only two years, then how is it possible that many patients reached the end point described in material and method. Even if we consider the date of paper submission as last date of study i.e. November 2008 only those cases which were operated before November 2006 would have been followed up for 2 years postoperatively ,which would amount to almost one third of the total patients only.
Why we are stressing on this is that the frequency of chronic groin pain reported by the author of 0.78% is extremely low compared to range of 0% to 37% of patients undergoing conventional hernia repair [1].
Johann Cunningham et al noted 12% incidence of moderate or severe pain one year after open hernia surgery [2]. Having said that, there are also series which have reported very low rates as well. Sergio Alfieri et al observed chronic severe pain in only 0.5% of patients at 1-year follow-up [3].
This is paramount in saying that if there is such a low incidence of chronic groin pain with polypropylene mesh than where is the need for all the light weight meshes which are being propagated.
This low rate reported is tremendous in that we should recommend the technique of surgery which has been used by the author and should standardize the procedure as pain free hernioplasty, but the only thing which I want to stress is that we should wait for full two year of follow up for all the patients before reaching to final conclusion. So for definitive evidence all patients should be followed for at least two years to completely calculate the incidence.
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Acknowledgments
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Contributor Information
Vanita Gupta, Phone: +91-755-2742348, Email: doctorvanita@yahoo.co.in.
Vikrant Singh, Email: vikrant1118@rediffmail.com.
References
- 1.Bay-Nielsen M, Nordin P, Nilsson E, Kehlet H. Danish hernia data base and the Swedish hernia data base. Operative findings in recurrent hernia after a Lichtenstein procedure. Am J Surg. 2001;182(2):134–136. doi: 10.1016/S0002-9610(01)00674-2. [DOI] [PubMed] [Google Scholar]
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