Prophylactic ilioinguinal neurectomy in open inguinal hernia repair: a randomized control trial

Hareesh Belagali; Darshan A. Manjunath; Ravindra Devani; Veerabhadra Radhakrishna

doi:10.18203/2349-2902.isj20180800

Authors

Hareesh Belagali Department of General Surgery, Basaveshwar Hospital, Mahadevappa Rampure Medical College, Gulbarga, Karnataka, India
Darshan A. Manjunath Department of General Surgery, McGann Hospital, Shivamogga Institute of Medical Sciences, Shivamogga, Karnataka, India
Ravindra Devani Department of General Surgery, KBN Hospital, Gulbarga, Karnataka, India
Veerabhadra Radhakrishna Department of Pediatric Surgery, Manipal Hospital, Kodihalli, Bengaluru, Karnataka, India http://orcid.org/0000-0002-8733-4892

DOI:

https://doi.org/10.18203/2349-2902.isj20180800

Keywords:

Ilioinguinal nerve, Inguinal hernia, Inguinal neuralgia, Neurectomy

Abstract

Background: Inguinal neuralgia is one of the important complications of hernia repair which occurs due to entrapment, neuroma or fibrotic reactions involving the ilioinguinal nerve. Hence the excision of ilioinguinal nerve should theoretically eliminate the possibility of inguinal neuralgia. But routine ilioinguinal neurectomy is still controversial and is not widely accepted. Hence a study was conducted to evaluate the effect of prophylactic ilioinguinal neurectomy in open inguinal hernia repair.

Methods: A prospective study was conducted in the General Surgery Department in a tertiary center for a period of 20 months, from December 2011 to July 2013. The patients were randomly allocated to either group A or group B by block randomized technique. Group ‘A’ patients underwent neurectomy of ilioinguinal nerve whereas the ilioinguinal nerve in group ‘B’ patients was safeguarded.

Results: A total of 60 patients were studied with 30 patients each in group A and group B. During vigorous activities, more group B patients had pain compared to group A patients at 4-month [15 (50%) vs. five (17%); p=0.006; Chi-square test] and 8-month follow-up [15 (50%) vs. five (17%); p=0.006; Chi-square test].

Conclusions: Inguinal neuralgia is a significant and debilitating complication following hernia repair. The prophylactic neurectomy can be an appropriate solution in the prevention of chronic groin pain following inguinal hernia repair and can be considered as an ideal inclusion into the standard hernia repair procedures.

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References

Bay-Nielsen M, Perkins FM, Kehlet H. Pain and functional impairment 1 year after inguinal herniorrhaphy: a nationwide questionnaire study. Ann Surg. 2001;233:1-7.

Abdullah TI, Iddon J, Barr L, Baildam AD, Bundred NJ. Prospective randomized controlled trial of preservation of the intercostobrachial nerve during axillary node clearance for breast cancer. Br J Surg. 1998;85:1443-5.

Picchio M, Palimento D, Attanasio U, Matarazzo PF, Bambini C, Caliendo A. Randomized controlled trial of preservation or elective division of ilioinguinal nerve on open inguinal hernia repair with polypropylene mesh. Arch Surg. 2004;139:755-8.

Manjunath DA, Gurugunti UD, Radhakrishna V. Laparoscopic transabdominal preperitoneal inguinal repair versus open Lichtenstein repair: a randomized control trial. Int Surg J. 2018;5(1):77-81.

Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res. 2011;63:S240-S252.

Baraz S, Zarea K, Shahbazian HB, Latifi SM. Comparison of the accuracy of monofilament testing at various points of feet in peripheral diabetic neuropathy screening. Journal of Diabetes and Metabolic Disorders. 2014;13:19.

White DK, Wilson JC, Keysor JJ. Measures of adult general functional status. SF-36 Physical Functioning Subscale (PF-10), Health Assessment Questionnaire (HAQ), Modified Health Assessment Questionnaire (MHAQ), Katz Index of Independence in Activities of Daily Living, Functional Independence Measure (FIM), and Osteoarthritis Function-Computer Adaptive Test (OA-Function-CAT). Arthritis Care Res. 2011;63:S297-S307.

Malekpour F, Mirhashemi SH, Hajinasrolah E, Salehi N, Khoshkar A, Kolahi AA. Ilioinguinal nerve excision in open mesh repair of inguinal hernia-results of a randomized clinical trial: simple solution for a difficult problem? Am J Surg. 2008;195:735-40.

Mui WL, Ng CS, Fung TM, Cheung FK, Wong CM, Ma TH, et al. Prophylactic ilioinguinal neurectomy in open inguinal hernia repair: a double-blind randomized controlled trial. Ann Surg. 2006;244:27-33.

Dittrick GW, Ridl K, Kuhn JA, McCarty TM. Routine ilioinguinal nerve excision in inguinal hernia repairs. Am J Surg. 2004;188(6):736-40.