Ilioinguinal Nerve Neurectomy is better than Preservation in Lichtenstein Hernia Repair: A Systematic Literature Review and Meta-analysis (original) (raw)
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World Journal of Surgery, 2021
Objective This study aimed to evaluate the incidence of chronic groin pain (primary outcome) and alterations of sensitivity (secondary outcome) after Lichtenstein inguinal hernia repair, comparing neurectomy with ilioinguinal nerve preservation surgery. Summary background data The exact cause of chronic groin postoperative pain after mesh inguinal hernia repair is usually unclear. Section of the ilioinguinal nerve (neurectomy) may reduce postoperative chronic pain. Methods We followed PRISMA guidelines to identify randomized studies reporting comparative outcomes of neurectomy versus ilioinguinal nerve preservation surgery during Lichtenstein hernia repairs. Studies were identified by searching in PubMed, Scopus, and Web of Science from April 2020. The protocol for this systematic review and meta-analysis was submitted and accepted from PROSPERO: CRD420201610. Results In this systematic review and meta-analysis, 16 RCTs were included and 1550 patients were evaluated: 756 patients underwent neurectomy (neurectomy group) vs 794 patients underwent ilioinguinal nerve preservation surgery (nerve preservation group). All included studies analyzed Lichtenstein hernia repair. The majority of the new studies and data comes from a relatively narrow geographic region; other bias of this meta-analysis is the suitability of pooling data for many of these studies. A statistically significant percentage of patients with prosthetic inguinal hernia repair had reduced groin pain at 6 months after surgery at 8.94% (38/425) in the neurectomy group versus 25.11% (113/450) in the nerve preservation group [relative risk (RR) 0.39, 95% confidence interval (CI) 0.28-0.54; Z = 5.60 (P \ 0.00001)]. Neurectomy did not significantly increase the groin paresthesia 6 months after surgery at 8.5% (30/353) in the neurectomy group versus 4.5% (17/373) in the nerve preservation group [RR 1.62, 95% CI 0.94-2.80; Z = 1.74 (P = 0.08)]. At 12 months after surgery, there is no advantage of neurectomy over chronic groin pain; no significant differences were found in the 12-month postoperative groin pain rate at 9% (9/100) in the neurectomy group versus 17.85% (20/112) in the inguinal nerve preservation group [RR 0.50, 95% CI 0.24-1.05; Z = 1.83 (P = 0.07)]. One study (115 patients) reported data about paresthesia at 12 months after surgery (7.27%, 4/55 in neurectomy group vs. 5%, 3/60 in nerve preservation group) and results were not significantly different between the two groups [RR 1.45, 95% CI 0.34, 6.21;Z = 0.51 (P = 0.61)]. The subgroup analysis of the studies that identified the IIN showed a significant reduction of the 6th month evaluation of pain in both groups and confirmed the same trend in favor of neurectomy reported in the previous overall analysis: statistically significant reduction of pain 6 months after surgery at 3.79% (6/158) in the neurectomy group versus 14.6% (26/178) in the nerve preservation group [RR 0.28, 95% CI 0.13-0.63; Z = 3.10 (P = 0.002)]. Conclusion Ilioinguinal nerve identification in Lichtenstein inguinal hernia repair is the fundamental step to reduce or avoid postoperative pain. Prophylactic ilioinguinal nerve neurectomy seems to offer some advantages concerning pain in the first 6th month postoperative period, although it might be possible that the small number of cases contributed to the insignificancy regarding paresthesia and hypoesthesia. Nowadays, prudent surgeons should discuss with patients and their families the uncertain benefits and the potential risks of neurectomy before performing the hernioplasty.
Journal of Evidence Based Medicine and Healthcare, 2020
BACKGROUND Chronic groin pain is a significant clinical problem in patients undergoing open hernia repair which interferes with daily activities. Traditional surgical technique dictates preservation of nerve; however, recent studies have shown that excision of nerve during hernia repair was associated with lower incidence of chronic groin pain. The aim of this study was to assess the effectiveness of prophylactic ilioinguinal neurectomy in reducing chronic groin pain following open hernia repair. METHODS 110 patients undergoing hernioplasty for inguinal hernia were divided into two groups. In group A, there were 55 patients who were subjected to prophylactic ilioinguinal neurectomy and in group B there were 55 patients in whom preservation of ilioinguinal nerve was done during the hernia repair. Patients were followed up at 1 month and 6 months following surgery to assess the incidence of chronic groin pain and pain during daily activities. RESULTS At 1 month follow up there was no significant difference between the two groups regarding incidence of chronic groin pain or pain during daily activities. However, the incidence of chronic groin pain was significantly lower in Group A compared to Group B at 6 months follow up. CONCLUSIONS Prophylactic ilioinguinal neurectomy during open hernia surgery significantly reduces the incidence of chronic groin pain without any morbidity.
International Surgery Journal, 2018
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 pa...
The American Surgeon, 2010
We conducted a randomized clinical trial on the impact of prophylactic ilioinguinal nerve excision (INE) on neuralgia, hypoesthesia, and analgesia requirement after open herniorrhaphy as well as on sustainability of a selective approach. Ninety-seven consecutive patients undergoing a Lichtenstein procedure were treated with INE (n = 45) or preservation (NP) (n = 52). Impact of patients’ age, gender, type of anesthesia, and hernia on outcomes was also evaluated by logistic regression analysis (LRA). Patients receiving INE reported less pain on postoperative days (POD) 1 and 7 and at 1 month and required less analgesia on POD 1. Overall younger patients (40 years old or younger) had more postoperative discomfort at LRA. Pain intensity was similar at 6 and 12 months after INE or NP: moderate to severe pain in 4.4 versus 11.5 per cent ( P = 0.279) and 4.4 versus 9.6 per cent ( P = 0.445), respectively. Hypoesthesia was more frequent after INE on POD 1 and 7:68.9 and 53.3 per cent versus...
Indian Journal of Surgery, 2018
Recently, with more attention to patient outcomes, chronic groin pain has replaced recurrence as the primary complication after open inguinal hernia repair. To compare and correlate the therapeutic effectiveness of routine ilioinguinal neurectomy versus nerve preservation with respect to post-operative groin pain, paraesthesia and patient well-being. The present study is a randomised study of 270 cases of inguinal hernias admitted in PDU Government Medical College and Hospital, Rajkot, during the study period of April 2012 to March 2014. The cases for the purpose of the study were selected on the basis of the random sampling method and after taking valid informed consent. For evaluation of chronic inguinal pain at different activities, P value for nerve preservation and neurectomy group was calculated and prophylactic ilioinguinal neurectomy was associated with less pain at varied activities. The incidence of post-operative hypoesthesia was more at 1-month follow-up in the neurectomy group. But, on further follow-up at 3 and 6 months, incidence was equal in each group. Prophylactic excision of ilioinguinal nerve during Lichtenstein open inguinal hernia tension-free meshplasty repair decreases the incidence of chronic groin pain after surgery.
Ilioinguinal Neurectomy and Chronic Post-Operative Pain After Inguinal Hernia Repair
Journal of Clinical and Biomedical Investigation, 2020
Objective: This study aims to determine the effect of preservation /division of ilioinguinal nerve in patients undergoing lichenstein hernioraphy on severity of chronic post operative pain as well well as presence /absence of groin numbness. Method: A randamised control trial was conducted for a period of six months on 60 patient fulfilling inclusion criteria who underwent lichenstein hernioraphy at general surgery department of Liaquat National university hospital Karachi , Pakistan. Result: A total of 60 patients undergoing elective inguinal hernia mesh repair were Included in study and divided in two groups with 30 patients each. Only male patients were included in the study as female gender was one of the exclusion criteria so gender stratification was no considered. Patients between 17 to 77 yrs of age were included in study and randomly divided in two groups. Mean age of population in group A is 42.96 +/- 17.76 an in group B is 54.23 +/- 15.0. The minimum age of the patient in...
The American Journal of …, 2008
BACKGROUND: Inguinodynia is the second most common complication occurring after inguinal hernia repair. This study was undertaken to evaluate the effect of ilioinguinal nerve excision, a concept previously proposed to be performed during open hernia mesh repair, on postsurgical pain and hyposthesia. METHODS: A double-blind randomized clinical trial was performed on 121 patients undergoing open anterior mesh repair of inguinal hernia in 1 center from April 2005 through June 2006. The ilioinguinal nerve was excised in half of the patients and preserved in the other half.
International Surgery Journal
Background: The objective of the study was to evaluate effect of prophylactic ilio-inguinal neurectomy on incidence of chronic groin pain following the Lichtenstein tension free hernioplasty for inguinal hernia.Methods: This prospective study included male cases admitted with uncomplicated inguinal hernia. Patients were categorised into two groups: Group A: Ilioinguinal nerve preserved, Group B: Ilioinguinal nerve excision. Standard tension-free Lichtenstein mesh repair was adopted. Patients were followed up for assessment of chronic groin pain, hypoesthesia, and numbness at post-operative day (POD) 3, POD14, 1 month and 3 months. Visual analog scale (VAS) was used to assess severity of pain. Sensory assessment was done using standard Semmes-Weinstein monofilament test. Student t test was used and a 2-sided p<0.05 was considered significant.Results: A total of 60 patients with uncomplicated inguinal hernia underwent Lichenstein mesh Hernioplasty (mean age of patients in nerve pre...
Elective ilio-inguinal neurectomy for prevention of chronic pain after inguinal hernia meshplasty
International Journal of Surgery Science, 2019
Background: This study has been carried out on 60 patients of inguinal hernia (either direct or indirect) from February 2016 to August 2017 who were admitted in the surgical ward of Index Medical College Hospital & Research Centre, Indore (M.P.). All patients were admitted through outpatient department. Method: The patients were divided into two groups: Group I and Group II. Each group consisted of 30 patients. Only male patients were included in the study. Surgery was organized within the hospital structure in the same way as other elective patients admitted in general surgical ward. Patient was fully explained about the procedure and its complications and was included in the study only after his written consent. Written explicit consent was taken in patients own language for group I patients. Result: The mean age of patients in nerve excision group (I) was 51.6 ± 18.1 years whereas in nerve preservation group (II) it was 50.3 ± 11.6 years. All the patients in both the groups were male. Patients suffering from pain were relatively much higher at 1 month irrespective of preservation or division of nerve. At 3 months after surgery both the groups had equal number of patients (2) with pain and continued resolution of pain symptom was thus noted. Conclusion: There is considerable evidence in world literature that supports the contention that in inguinal Hernia Meshplasty Neurectomy is associated with decreased incidence of pain after open hernia surgery. Keeping in mind the results emerging from the present study it may be suggested that routine identification and elective excision of the ilioinguinal nerve may be reasonable option without any significant added morbidity to prevent the chronic; pain in inguinal hernia repair with mesh. But a larger prospective randomized study is still required to confirm the benefit benefits of routine ilioinguinal neurectomy while doing open inguinal hernia repair with mesh.