Difference of Neutrophil to Lymphocyte Ratio (NLR) Value and Pain Scale in Herniorrhaphy Surgery with Mesh and Non-Mesh Repair

Abstract

Introduction: Inguinal hernia accounts for 75% of all abdominal wall hernias. Herniorrhaphy becomes the definitive procedure for inguinal hernia. This procedure is aimed to close the defect and perform tension-free repair using Mesh. However, the use of mesh has been associated with increasing of several complications such as risk of infection and inflammation which lead to chronic post-operative pain. Objective: Our study objective is to analyze the difference of herniorrhaphy Mesh and Non-mesh Repair method based on the neutrophil to lymphocyte ratio (NLR) value and visual pain scale. Method: An experimental study with post-only design, single blind involving hernia patients who were indicated to undergo herniorrhaphy surgery. Research subjects were obtained by consecutive sampling until the minimum sample size of the study was fulfilled. Patients who fulfilled the inclusion criteria, did not have exclusion criteria, and were willing to participate in the study would become research subjects. Evaluation was performed on neutrophil to lymphocyte ratio (NLR) value and pain scale at 4 hours after surgery. Pain scale was measured using visual analogue scale (VAS) measurement tool with scale 0-10, where score 0 means no pain and score 10 means severe pain. Results: NLR value in the mesh group was significantly higher compared to the non-mesh group (8.56 ± 1.87 vs 4.56 ± 1.5; p<0.001). Correlation evaluation found that there was a significant correlation between NLR value and VAS score with moderate positive correlation level (p=0.023; r=0.400). Conclusion: Inguinal hernia patients who underwent herniorrhaphy with mesh method significantly had higher NLR value compared to non-mesh group. The increasing of NLR value has been associated with the increasing degree of pain based on VAS score.