Postoperative pain after abdominal wall reconstruction for midline incisional hernias: a comparative analysis of different hernia repair techniques

Background. Postoperative pain is one of the key indicators for evaluating the effectiveness of abdominal wall reconstruction, as it determines the course of the early postoperative period, the possibility of early patient mobilization, and the rate of functional recovery. However, the impact of different hernia repair techniques on the intensity of postoperative pain in patients with midline incisional hernias remains poorly investigated. The purpose was to evaluate the intensity and duration of postoperative pain in patients with EHS W2-W3 incisional ventral hernias following different abdominal wall reconstruction techniques. Materials and methods. This prospective study included 124 patients with EHS M1-M4, W2-W3 incisional hernias. Twenty-five (20.2 %) of them underwent horizontal aponeurotic reinforced procedure (HARP), 36 (29.0 %) underwent Rives-Stoppa repair, 40 (32.3 %) underwent Ramirez anterior component separation, and 23 (18.5 %) underwent transversus abdominis release (TAR). Postoperative pain was assessed using the 11-point Numeric Rating Scale (NRS-11) during the first three postoperative days. Results. A gradual decrease in postoperative pain intensity was observed in all study groups during the first three postoperative days. The lowest pain scores at all assessment time points were recorded after HARP (NRS-11: 2.88 ± 1.77, 1.20 ± 1.68, and 0.44 ± 0.51, respectively), whereas the highest scores were observed after TAR (5.52 ± 4.32, 4.04 ± 2.72, and 2.55 ± 1.45, respectively). Following HARP, the proportion of pain-free patients increased significantly from 20.0 to 56.0 % (p = 0.030), while moderate pain was completely eliminated by postoperative day 3 (p = 0.007). After Rives-Stoppa repair, there was also a significant increase in the proportion of pain-free patients (p = 0.016) and a significant reduction in the incidence of severe pain (p = 0.009). In the Ramirez and TAR groups, only trends towards a decrease in pain intensity were noted, without statistically significant changes in most of the studied indicators. Conclusions. Postoperative pain intensity gradually decreased in all groups during the first three postoperative days; however, the magnitude of this dynamics depended on the hernia repair technique. HARP demonstrated the most favorable outcomes, with the lowest postoperative pain intensity throughout the observation period and the most rapid reduction in the frequency of moderate and severe pain. In contrast, TAR was associated with the highest postoperative pain scores, whereas Rives-Stoppa repair and Ramirez anterior component separation showed intermediate results.