Ilio inguinal neurectomy in inguinal hernia

Abstract

Background: Inguinal hernia is one of the most common surgery done in any hospital. Chronic inguinal pain is one of the common problem these patients complain of. This study aims at evaluating the long-term outcomes of neuralgia and paraesthesia following routine ilioinguinal nerve division, compared to nerve preservation when performing Lichtenstein’s inguinal hernia repair.Methods: The present study is a randomized controlled trial of 60 cases of inguinal hernias admitted in General Surgery Department in our hospital. The patients were randomly chosen into Lichtenstein hernia repair with ilioinguinal neurectomy or Lichtenstein hernia repair with nerve preservation. After surgery, all patients were monitored carefully for pain and paraesthesia. Pain was assessed using visual analogue scale. Paraesthesia was assessed by the monofilament test and evaluated after comparison with the opposite side.Results: In the present study, the incidence of pain as well as the severity of pain is far higher in the nerve preservation study group as opposed to the neurectomy study group. Hypaesthesia is not a significant complication following ilioinguinal neurectomy and does not significantly add to the morbidity of the patient.Conclusions: Prophylactic neurectomy can be an appropriate solution in the prevention of chronic groin pain following Lichtenstein inguinal hernia repair and can be considered as an ideal inclusion into the standard hernia repair procedures. Hypoesthesia is not a significant complication following ilioinguinal neurectomy and does not significantly add to the morbidity of the patient.

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

“…While the oldest was 78 and 72 years in both the neurectomy group and the nerve preservation group, respectively. 17 Sunkar et al reported that 8% of his patients aged between 15-30 years and 34% aged between 61and 75 years old. 18 Saravanan et al reported that most of his patients aged between 31 to 40 years in both groups followed by 41 to 50 years.…”

“…Mohanapriya et al reported a similar result and stated that pain at rest was present in 10% of his patients in the nerve preservation group after 8 months and it was statistically insignificant. 17 Also Saravanan et al reported that at one-month pain at rest was found in only one patient in the neurectomy group against six patients in the nerve preserving group, while after 6 months none of the neurectomy group felt pain at rest while 3 patients of the other group were still feeling pain at rest. 19 On the other hand, Neogi et al reported that the mean of group A patients of 0.6 was less than group B (1.05) showing that postoperative pain after one month in group A was less than group B.…”

“…Also, he found that the difference in the incidence of pain between the 2 groups was statistically significant. 17 Saravanan et al reported that 4 of his patients experienced pain with activity after 1 month, 2 patients in each group, whereas, after 6 months only one patient experienced pain with activity in the neurectomy group while in the nerve preserving group the 2 patients were still suffering pain with activity. 19 Neogi et al reported that the mean of group A of (0.25) was less than group B (0.77) showing that postoperative pain after three months in group A was less than group B.…”

“…At 8 months post-operative the pain was still present in 11 patients in the nerve preservation group against only 4 patients in the neurectomy group and the difference was statistically significant. 17 Also, Sunkar et al reported that a significantly lesser number of patients had pain after cycling for 20 minutes at 6 months in the neurectomy group as compared with the non-neurectomy group. 18 Whereas, Picchio and colleagues suggested that nerve preservation and nerve division have similar incidences of pain and that intraoperative nerve division just leads to an increased rate of wound anesthesia.…”

“…The least incidence was that of the left direct hernia. 17 Saravanan reported that 58% of his patients underwent right indirect hernia repair. The least was the left direct hernia.…”