A prospective study comparing prophylactic division versus preservation of the ilioinguinal nerve in open Lichtenstein inguinal hernioplasty
DOI:
https://doi.org/10.18203/2349-2902.isj20210074Keywords:
Inguinal hernia, Mesh hernioplasty, Post-operative pain ilioinguinal nerve, Neurectomy, nerve preservationAbstract
Background: Inguinal hernia is one of the most common surgeries done all over the world. Chronic groin pain is one of the most annoying problems after mesh hernioplasty. This study aimed at evaluating the incidence of chronic groin pain and numbness occurring after prophylactic ilioinguinal neurectomy, as compared to its preservation during Lichtenstein’s inguinal hernioplasty.
Methods: This prospective randomized study involved 90 patients complaining of inguinal hernias admitted to the department of general surgery, Tanta university hospitals during the study period. Our patients were divided randomly in two equal groups. (Group A) patients were subjected to Lichtenstein hernia repair with ilioinguinal neurectomy while (group B) patients were subjected to Lichtenstein hernia repair with nerve preservation. Post-operatively the incidence of groin pain and numbness were assessed in all patients. The pain was evaluated using a visual analogue scale. Whereas numbness was examined by the monofilament test and evaluated in comparison to the opposite side.
Results: In the present study, the incidence of pain was higher in nerve preservation study group whereas, numbness was not a major complication after prophylactic ilioinguinal nerve division and did not add to patient morbidity.
Conclusions: Prophylactic ilioinguinal nerve division could be an appropriate and beneficial solution for chronic groin pain after the Lichtenstein procedure and may be added as a surgical step during the classic procedures for hernia repair. Also, numbness was not a major complication after the prophylactic division of the ilioinguinal nerve and did not add to the patient morbidity.
References
Courtney CA, Duffy K, Serpell MG, O'dwyer PJ. The outcome of patients with severe chronic pain following repair of groin hernia. Br J Surg. 2002;89(10):1310-4.
Amid PK. Causes, prevention, and surgical treatment of post herniorrhaphy neuropathic inguinodynia: triple neurectomy with proximal end implantation. Hernia. 2004;8(4):343-9.
Aasvang E, Kehlet H: Chronic postoperative pain: the case of inguinal herniorrhaphy. Br J Anaesth 2005;95(2):69-76.
Bay-Nielsen M, Nilsson E, Nordin P, Kehlet H. Chronic pain after open mesh and sutured repair of indirect inguinal hernia in young males. Br J Surg. 2004;91(2):1372-6.
Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain, Subcommittee on Taxonomy. Pain Suppl. 1986;3(6):S1-226.
Kehlet H, Bay-Nielsen M, Kingsnorth A. Chronic post herniorrhaphy pain–a call for a uniform assessment. Hernia 2002;6(6):178-81.
Fitzgibbons RJ Jr, Filipi CJ, Quinn TH. Inguinal hernia. In: (editor) Schwartz’s Principles of Surgery. 8th ed. McGraw Hill. 2005;1385-3.
Geis WP, Singh K, Gillian GK. An algorithm for the treatment of chronic pain after inguinal herniorrhaphy. In: Fitzgibbons RJ Jr, Greenburg AG (editors) Nyhus and Condon’s Hernia. 5th ed. Philadelphia, PA: Lippincott Williams and Wilkins. 2002:307-16.
Bell JA. Semmes-Weinstein monofilament testing for determining cutaneous light touch/deep pressure sensation. Star. 1984;44(2).
Callesen T, Bech K, Kehlet H. Prospective study of chronic pain after groin hernia repair. Br J Surg. 1999;86(12):1528-31.
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):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;88(8):1122-6.
Ravichandran D, Kalambe BG, Pain JA. A pilot randomized controlled study of preservation or division of ilioinguinal nerve in open mesh repair of inguinal hernia. Br J Surg. 2000;87(9):1166-7.
Ferzli GS, Edwards ED, Khoury GE. Chronic pain after inguinal herniorrhaphy. J Am Coll Surg. 2007;205(2):333-41.
Kalliomaki ML, Meyerson J, Gunnarsson U. Long-term pain after inguinal hernia repair in a population-based cohort: risk factors and interference with daily activities. Eur J Pain. 2008;12(2):214-25.
Dennis R, O’Riordan D. Risk factors for chronic pain after inguinal hernia repair. Ann R Coll Surg Engl. 2007;89(3):218-20.
Mohanapriya T, Karthikeyan TR, Singh KB, Arulappan T. Ilio inguinal neurectomy in inguinal hernia. Int Surg J. 2017;4:2977-82.
Sunkar S, Brashier DBS, Bhagwat K, Sharma V, Ang P. A clinical study of the incidence and disability caused by mesh neuralgia after inguinal mesh hernioplasty and the effects of prophylactic ilioinguinal neurectomy and its role in preventing chronic groin pain after inguinal hernioplasty. Int Surg J. 2018;5:1083-9.
Saravanan K, Umamaheswari T. Short term outcome of ilioinguinal neurectomy in reducing chronic pain after an inguinal hernia. Int J Contem Med Surg Radiol. 2019;4(1):A78-80.
Neogi P, Singh SK, Manwatkar S, Singh SK, Saxena A, Kola A. A prospective study comparing preservation of ilioinguinal nerve with neurectomy in open mesh repair of inguinal hernia. Int Surg J. 2019;6:114-8.
Picchio M, Marcello P, Palimento D. RCT of preservation or elective division of ilioinguinal nerve on open mesh repair. Arch Surg. 2004;139(8):755-8.
