A pragmatic approach to cutaneous nerve division during open inguinal hernia repair

Abstract

The division of cutaneous nerves during inguinal hernia repair has no significant effect on postoperative pain. However, there are very few adverse outcomes, and so, a pragmatic approach of dividing nerves when they would otherwise be damaged may be appropriate.

Questioning the favorable influence of nerve identification during open inguinal herniorrhaphy is misleading and may increases the risk of surgeons’ liability

“…Reducing the rate of chronic pain does not come from identification alone, but rather, the information obtained should guide proper management of the nerves. ''At-risk'' nerves should be resected with proximal intramuscular reimplantation to prevent injury and pain [1,8]. Management of the divided iliohypogastric nerves was not specified, but potentially could play a role in the incidence of chronic pain.…”

“…Management of the divided iliohypogastric nerves was not specified, but potentially could play a role in the incidence of chronic pain. Additionally, using consensus guidelines, the additional three patients demonstrating a ''nerve lesion'' would be recommended to have a pragmatic neurectomy of the affected nerve at the initial repair [1,3,8].…”

Randomized controlled multicenter international clinical trial of self-gripping Parietex™ ProGrip™ polyester mesh versus lightweight polypropylene mesh in open inguinal hernia repair: interim results at 3 months

“…[7]. Further confounding the discussion, recent reviews have suggested that better results are obtained if the nerves are identified and either protected from injury or systematically divided if they are in danger of suffering incidental damage during surgery [8][9][10][11][12].…”

Pain following the repair of an abdominal hernia

“…2,18,[77][78][79][80][81][82] In fact, some surgeons recommend that all the nerves should be identifi ed during open surgery. 83 However, this has to be balanced with the potential risk of tissue damage during the dissection process and the lack of knowledge of the long-term effects.…”