A prospective study comparing preservation of ilioinguinal nerve with neurectomy in open mesh repair of inguinal hernia

Abstract

Background: Postoperative pain after open mesh repair of inguinal hernia is an important challenge. Such type of pain sometimes does not respond to medical treatment including non-steroidal anti-inflammatory drugs and opiates. The objective of the present study was to evaluate the effect of preservation or division of the Ilioinguinal nerve on pain and post-operative symptoms, after open mesh repair of inguinal hernia.Methods: All patients undergoing surgery for tension free Lichtenstein mesh repair over a period of 1 year were included. Patients below the age of 18 years and patients with bilateral or recurrent hernias were excluded.Results: In present study of 42 patients, early mean postoperative pain at day 1 was 1.8 on VAS scale in ilioinguinal neurectomised patient compared to 1.5 in nerve preserved group (P=0.1408). Postoperative pain at week 1 was 1.25 in neurectomised patients compared to 1.32 in nerve preserved group (P=0.7161). Late Postoperative pain and chronic groin pain was 0.6 and 0.25 at 1 and 3 months respectively in ilioinguinal neurectomised patients as compared to 1.05 and 0.77 at 1 and 3 months respectively in nerve preserved group (P=0.0184 at 1month and P=0.0335 at 3 months).Conclusions: The difference in postoperative pain at day 1 and at week 1 was not significant and both groups had equal pain. Late postoperative pain (at 1 month) and chronic groin pain (at 3 months) was significantly low in ilioinguinal neurectomised patient compared to nerve preserved group.

A prospective study comparing prophylactic division versus preservation of the ilioinguinal nerve in open Lichtenstein inguinal hernioplasty

“…The difference in pain in the two groups was also statistically significant and the twotailed p value was 0.0184 (<0.05). 20 In the present study after one month follow up the pain after normal daily activities were present in 40% of patients in the neurectomy group (A) and 33.3% in the nerve preservation group (B). Pain during normal daily activities was noted in 11.1% in the neurectomy group and 24.4% in the nerve preservation group after 6 months follow up.…”

“…In the nerve preserved group 7, 5 and 2 patients had groin numbness at 7 days, 1 month, and 3 months, respectively with no statistically significant difference between both groups. 20 Mohanapriya reported that the incidence of post-operative numbness was higher in the neurectomy group at the 8 months follow-up. The incidence of hyperesthesia was high in both the study groups at 1 month follow up.…”

“…The difference in pain in the two groups was again statistically significant and the two-tailed p value was 0.0335 (<0.05). 20 Also, Sunkar et al reported that significantly fewer patients had pain after coughing 5 times at 6 months, in the neurectomy group as compared with the nonneurectomy group (p value<0.0001). 18 In the present study, after 1 month follows up, pain during vigorous activity was noted in 48.9% of patients in the neurectomy group (A), while it was noted in 55.6% of patients in the nerve preservation group (B).…”

“…Neogi et al reported that hernias were right and left in 29 patients and 13 patients, respectively. 20 Mohanapriya reported that the incidence of right indirect hernia was 40% in the neurectomy group and 43.3% in the nerve preservation group. The least incidence was that of the left direct hernia.…”

Authors’ Reply: Ilioinguinal Nerve Neurectomy is better than Preservation in Lichtenstein Hernia Repair: A Systematic Literature Review and Meta‐analysis

“…For the remaining 31 studies, the full texts were obtained and reviewed. Sixteen studies were included [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43], and 15 studies were excluded from the meta-analysis (three were not randomized [44][45][46], six RCTs performed a short follow-up [47][48][49][50][51][52], in three RCTs the timing of the follow-up was different from 6 and 12 months [53][54][55], two RCTs used the sutureless Trabucco technique [56,57], and one RCT analyzed the neurectomy of the iliohypogastric nerve [58]).…”