Clinical Report: Chronic Postsurgical Pain After Incisional Hernia Surgery
Overview
Chronic postsurgical pain (CPSP) is a significant but often overlooked complication following open incisional hernia repair, with incidence rates varying widely. This retrospective study analyzed patients undergoing retromuscular mesh repair to identify CPSP incidence, risk factors, and the impact of perioperative pain management.
Background
Incisional hernias occur in 3–20% of patients after open abdominal surgery and often require surgical repair due to pain or functional limitations. Despite successful anatomical repair, many patients develop CPSP, defined as pain lasting at least three months postoperatively that interferes with daily life. Previous studies report chronic pain rates after laparoscopic hernia repair between 26.2% and 39%, but data on open repair and associated risk factors remain limited. Understanding CPSP's incidence and predictors is crucial for optimizing perioperative analgesia and improving patient outcomes.
Data Highlights
The study included patients undergoing open incisional hernia repair with retromuscular mesh placement from 2015 to 2021. Data collected encompassed patient demographics, comorbidities, surgical details, and postoperative outcomes including pain assessment via the EuraHS Quality of Life questionnaire. Pain was quantified using a CPSP score (0–30), daily-life limitation score (0–40), cosmetic outcome (0–10), and overall quality of life (0–80). Complex hernias were defined as defects >10 cm. The study aimed to correlate these variables with CPSP incidence and perioperative analgesic use.
Key Findings
CPSP is a frequent complication after open incisional hernia repair, with pain persisting beyond three months post-surgery.
Risk factors identified in prior studies include strong preoperative pain, younger age, and female gender; this study further investigates these and other factors.
Perioperative analgesic management's role is unclear—whether increased analgesic use is a risk factor or protective remains to be determined.
Patients with CPSP report significant limitations in daily activities and reduced quality of life despite successful hernia repair.
Surgical interventions for CPSP, such as mesh replacement or suture removal, are rare and carry additional risks.
Validated tools like the EuraHS QoL questionnaire provide structured assessment of pain, functional limitations, and cosmetic outcomes post-surgery.
Clinical Implications
Clinicians should recognize CPSP as a common and impactful outcome after incisional hernia repair and incorporate routine pain assessment into postoperative follow-up. Identifying patients at higher risk may allow tailored perioperative analgesic strategies to minimize chronic pain development. Multimodal pain management and patient education about potential long-term pain are essential to improve satisfaction and functional recovery.
Conclusion
Chronic postsurgical pain following open incisional hernia repair is a prevalent and debilitating condition that warrants greater clinical attention. Further research is needed to clarify risk factors and optimize perioperative pain control to reduce CPSP incidence and improve patient quality of life.
References
EuraHS Quality of Life Questionnaire Development and Validation
ICD-11 Definition of Chronic Postsurgical Pain
Studies on Chronic Pain After Laparoscopic Hernia Repair
Charlson Comorbidity Index for Risk Stratification
Clavien–Dindo Classification of Surgical Complications
Patients with preoperative vitamin D deficiency had higher postoperative pain scores and opioid use after mastectomy, including more than triple the odds of moderate to severe pain within 24 hours of surgery.
