Evaluation of Chronic Postoperative Groin Pain After Inguinal Hernia Repair: A Comparative Study of Open and Laparoscopic Surgical Techniques.

Abstract

Background: Chronic postoperative groin pain (CPGP), defined as pain persisting beyond three months following inguinal hernia repair, is now recognised as the most clinically significant long-term complication of this common operation. Its incidence and severity may vary substantially between open and laparoscopic surgical approaches, but comparative data from Indian tertiary-care centres remain limited. Aim: To evaluate and compare the incidence, severity and functional impact of chronic postoperative groin pain in patients undergoing open Lichtenstein tension-free mesh repair versus laparoscopic total extraperitoneal (TEP) repair for uncomplicated primary inguinal hernia. Materials and Methods: This prospective, non-randomised, comparative observational study was conducted at the Department of General Surgery, The Oxford Medical College Hospital and Research Centre, Bangalore, between 22 February 2026 and 22 May 2026. Forty-five adult patients with uncomplicated unilateral primary inguinal hernia were allocated to either open Lichtenstein repair (Group A, n = 23) or laparoscopic TEP repair (Group B, n = 22) based on surgeon preference and patient choice after informed consent. Pain was assessed using the Visual Analog Scale (VAS) and the Inguinal Pain Questionnaire (IPQ) at 24 hours, one week, one month and three months postoperatively. Perioperative variables, complications and return-to-work interval were recorded. Statistical analysis was performed using SPSS v26.0; p < 0.05 was considered significant. Results: Both groups were comparable at baseline (p > 0.05). Mean VAS scores were significantly lower in the laparoscopic group at every time point: 24 h (4.1 ± 1.2 vs 6.2 ± 1.4, p < 0.001), one week (2.2 ± 0.9 vs 3.8 ± 1.1, p < 0.001), one month (1.3 ± 0.7 vs 2.1 ± 1.0, p = 0.003) and three months (0.7 ± 0.8 vs 1.4 ± 1.2, p = 0.021). At three months, CPGP of any severity was reported by 9/23 (39.1 %) in the open group versus 5/22 (22.7 %) in the laparoscopic group (p = 0.234); moderate-to-severe pain (VAS ≥ 4) occurred in 3/23 (13.0 %) versus 1/22 (4.5 %) respectively. Mean operative time was longer in the laparoscopic group (78.4 ± 15.7 vs 62.5 ± 12.3 min, p < 0.001), whereas hospital stay (1.6 ± 0.6 vs 2.8 ± 0.9 days, p < 0.001) and return to work (9.4 ± 3.1 vs 18.2 ± 4.5 days, p < 0.001) were significantly shorter. Complication rates were comparable. Conclusion: Laparoscopic TEP repair was associated with a lower mean intensity of chronic postoperative groin pain, faster convalescence and earlier return to work compared with open Lichtenstein repair, although the difference in overall CPGP incidence did not reach statistical significance in this small cohort. Larger multicentric randomised trials are warranted to consolidate these findings.