Impact of Mesh Fixation Methods on Chronic Pain and Postoperative Quality of Life Following Inguinal Hernia Repair: A Single-Centre Retrospective Study Based on Propensity Score Matching

Background To compare penetrating versus non-penetrating mesh fixation in inguinal hernia repair in terms of chronic pain and quality of life, and to explore factors associated with chronic postoperative pain. Methods This single-centre retrospective cohort study enrolled adults who underwent inguinal hernia repair at Chifeng Cancer Hospital between January 2018 and January 2024, whose fixation method was documented intraoperatively and who completed ≥ 6 months of follow-up. Patients were assigned to a penetrating group (suture or tacker) or a non-penetrating group (glue or self-gripping mesh), with propensity score matching (PSM) to control for confounders. Baseline characteristics, perioperative outcomes, pain visual analogue scale (VAS) scores before surgery and at 3 and 6 months postoperatively, and Carolinas Comfort Scale (CCS) scores at 6 months postoperatively were compared between groups. Logistic regression was used to explore factors associated with chronic postoperative pain, with rare events logistic regression and Poisson regression as sensitivity analyses. Results Of 249 patients assessed, 175 were included and, before matching, 117 and 58 were enrolled in the penetrating and non-penetrating groups, respectively; after PSM, 98 and 49 were analysed. Before matching the groups differed in age distribution, whereas after matching no baseline variable differed significantly. Perioperative outcomes—surgical approach, operation time, length of hospital stay, mesh type, and complications—did not differ significantly between groups. The incidence of chronic postoperative pain was higher in the penetrating than in the non-penetrating group (8.2% vs 4.1%), but not significantly so (P = 0.497). VAS scores at 3 and 6 months postoperatively and the total and several domain scores of the CCS at 6 months postoperatively favoured the non-penetrating group (all P < 0.05). In the multivariable logistic regression, non-penetrating fixation and a lower preoperative VAS score were each associated with lower odds of chronic postoperative pain, and the direction of effect was consistent across sensitivity analyses. Because only 2 chronic pain events occurred in the non-penetrating group, however, these findings are exploratory. Conclusions Non-penetrating mesh fixation may offer advantages in reducing chronic postoperative pain and improving quality of life. Fixation method and preoperative VAS score were associated with chronic pain, suggesting that fixation strategies should be optimised according to individual patient characteristics; these associations are hypothesis-generating, however, given the small number of chronic pain events.