University of Oregon

Department of Human Physiology Graduate Studies in Athletic Training and Sports Medicine

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Effect of Hernia Surgical Procedures on Rehabilitation Time

Greg Waltner MS, ATC

Chronic pain after hernia repair: a randomized trial comparing Shouldice, Lichtenstein and TAPP. Köninger, J; Redecke, J; Butters, M. Langenbecks Archives of Surgery. 2004 Oct; 389(5): 361-5.

Clinical Question:
How does postoperative pain compare between the three major standardized techniques of hernia repair?

Prospective randomized clinical trial.

Two hundred and eighty males diagnosed with primary hernias.

Shouldice, Lichtenstein, and Laparoscopic transabdominal pre-peritoneal (TAPP) herniaplasties. Main Outcome Measures: A standardized interview and visual analog scale (VAS) ranging from 0 to 100 was used to measure the patient’s discomfort and pain.

No pain was reported in 84% of TAPP patients, 62% of Shouldice patients, and 68% of Lichtenstein patients. Intense pain was reported in 3% of Shouldice and Lichtenstein and 0% in TAPP patients respectively. Visual Analog Scale median scores were: Shouldice 35 (10-75), Lichtenstein 33 (10-73), and TAPP 15 (10-68). Fifteen percent of Shouldice patients, 13% of Lichtenstein patients and 2.4% of TAPP patients felt limited performing physical activities.

Laparoscopic TAPP repair resulted in a significantly lower frequency of postoperative pain than did Shouldice and Lichtenstein procedures.

Current literature supports the use of laparoscopic surgery for athletes who suffer from chronic groin pain as a result of either a palpable hernia or a “sports hernia” enabling them to return to full activity more quickly with a minimal risk of recurrence.

Groin pain, Hernia, Sports hernia, Laparoscopic repair, Shouldice, Lichtenstein.