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

Probal Neogi, Santosh Kumar Singh, Soumitra Manwatkar, Sunil Kumar Singh, Abhishek Saxena, Anish Kola


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.


Hernioplasty, Ilioinguinal neurectomy, Inguinal hernia, Lichtenstein mesh repair, Postoperative pain

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Sakorafas GH, Halikias I, Nissotakis C, Kotsifopoulos N, Stavrou A, Antonopoulos C, et al. Open tension free repair of inguinal hernias; the Lichtenstein technique. BMC surgery. 2001 Dec;1(1):3.

Lichtenstein IL, Shulman AG, Amid PK, Montllor MM. The tension-free hernioplasty. Am J Surg. 1989 Feb 1;157(2):188-93.

Courtney CA, Duffy K, Serpell MG, O'dwyer PJ. Outcome of patients with severe chronic pain following repair of groin hernia. Br J Surg. 2002 Oct;89(10):1310-4.

Amid PK. Causes, prevention, and surgical treatment of postherniorrhaphy neuropathic inguinodynia: triple neurectomy with proximal end implantation. Hernia. 2004 Dec 1;8(4):343-9.

Starling JR, Harms BA. Diagnosis and treatment of genitofemoral and ilioinguinal neuralgia. World J Surg. 1989 Sep 1;13(5):586-91.

Bell JA. Semmes-Weinstein monofilament testing for determining cutaneous light touch/deep pressure sensation. Star. 1984 Nov;44(2).

Callesen T, Bech K, Kehlet H. Prospective study of chronic pain after groin hernia repair. Br J Surg. 1999 Dec 1;86(12):1528-31.

Bay-Nielsen M, Perkins FM, Kehlet H. Pain and functional impairment 1 year after inguinal herniorrhaphy: a nationwide questionnaire study. Annals of surgery. 2001 Jan;233(1):1-7.

Poobalan AS, Bruce J, King PM, Chambers WA, Krukowski ZH, Smith WC. Chronic pain and quality of life following open inguinal hernia repair. Br J Surg. 2001 Aug;88(8):1122-6.

Ravichandran D, Kalambe BG, Pain JA. Pilot randomized controlled study of preservation or division of ilioinguinal nerve in open mesh repair of inguinal hernia. Br J Surg. 2000 Sep 1;87(9):1166-7.

Dittrick GW, Ridl K, Kuhn JA, McCarty TM. Routine ilioinguinal nerve excision in inguinal hernia repairs. Am J Surg. 2004 Dec 1;188(6):736-40.

Wantz GE. Testicular atrophy and chronic residual neuralgia as risks of inguinal hernioplasty. Surg Clin North Am. 1993 Jun 1;73(3):571-81.

Malekpour F, Mirhashemi SH, Malekpour F, Mirhashemi SH, Hajinasrolah E, Salehi N, et al. Ilioinguinal nerve excision in open mesh repair of inguinal hernia-results of a randomized clinical trial: simple solution for a difficult problem?. The Am J Surgery. 2008 Jun 1;195(6):735-40.

Khoshmohabat H, Panahi F, Alvandi AA, Mehrvarz S, Mohebi HA, Koushki ES. Effect of ilioinguinal neurectomy on chronic pain following herniorrhaphy. Trauma Monthly. 2012;17(3):323-8.

Baer A, Bohnert N, Goretzki PE, Lammers BJ. Resection of ileoinguinal and ileohypogastric nerves combined with gluing in modified lichtenstein repair. Surg Technol Int. 2015 May;26:143-8.

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 Jul 1;139(7):755-8.

Hsu W, Chen CS, Lee HC, Liang HH, Kuo LJ, Wei PL, et al. Preservation versus division of ilioinguinal nerve on open mesh repair of inguinal hernia: a meta-analysis of randomized controlled trials. World J Surg. 2012 Oct 1;36(10):2311-9.

Ogawa N, Kawai H, Terashima T, Kojima H, Oka K, Chan L, Maegawa H. Gene therapy for neuropathic pain by silencing of TNF-α expression with lentiviral vectors targeting the dorsal root ganglion in mice. PLoS One. 2014 Mar 18;9(3):e92073.

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. Annals of surgery. 2006 Jul;244(1):27-33.