Postoperative Pain in Mesh versus Non-Mesh Inguinal Hernia Repair: A Comparative Retrospective Study from a South Indian Tertiary Care Centre

Abstract

Background: Inguinal hernia repair remains one of the most frequently performed elective general surgical procedures, with mesh-based (tension-free) and non-mesh (tissue-based) techniques representing the two principal approaches. While mesh repair is associated with lower recurrence, its relationship with acute and chronic postoperative pain compared with non-mesh repair remains debated, particularly in Indian tertiary-care populations.

Objective: To compare acute and chronic postoperative pain, analgesic requirement, functional recovery, and complications between mesh and non-mesh inguinal hernia repair, and to identify predictors of chronic post-herniorrhaphy pain.

Methods: This retrospective comparative observational study included 220 patients (110 mesh, 110 non-mesh) undergoing elective open unilateral inguinal hernia repair over a 3-month period. Pain was assessed using the Numerical Rating Scale (NRS, 0–10) at 24 hours, 48 hours, 7 days, 1 month, and 3 months. Analgesic consumption, return to activity, complications, and quality of life (EQ-5D-3L) were recorded. Predictors of chronic pain were identified using multivariate logistic regression, and receiver operating characteristic (ROC) analysis evaluated the predictive value of the 24-hour NRS score.

Results: Mean NRS scores were significantly lower in the mesh group at 24 hours (4.1 ± 1.2 vs 5.3 ± 1.4, p<0.001), 48 hours, and 7 days. Analgesic consumption (42.6 ± 12.3 mg vs 58.9 ± 15.7 mg morphine-equivalent) and return to normal activity (9.8 ± 3.2 vs 13.4 ± 4.1 days) favoured the mesh group. However, chronic pain at 3 months was numerically higher after mesh repair (16.4% vs 10.9%, p=0.21). NRS ≥5 at 24 hours independently predicted chronic pain (odds ratio 3.4, 95% CI 1.9–6.1), with an area under the ROC curve of 0.78.

Conclusion: Mesh repair confers a clear advantage in acute pain control, analgesic sparing, and early functional recovery, without a statistically significant excess of chronic pain in this cohort. Early pain severity is a strong predictor of chronic post-herniorrhaphy pain and may guide targeted follow-up.