Elective Division Versus Preservation of The Ilioinguinal Nerve to Reduce Postoperative Pain in Hernioplasty for Inguinal Hernia

Abstract

Background: Lichtenstein tension-free mesh hernioplasty is the gold standard and the method of choice for the repair of inguinal hernia in developed countries. Chronic post-operative inguinal pain (CPIP), which is defined as pain lasting at least 2–3 months after surgery, is a major problem that affects about 8-16 % of inguinal hernia patients and affects their daily lives. Pain can be caused by perioperative injury to nerves or nerves that are being trapped and impaired by sutures or perforated by fixation devices such as tacks. Ilioinguinal nerve trauma throughout dissection, inflammation or fibrosis, and nerve entrapment by the mesh have all been involved in the pathogenesis of inguinodynia.

Objective: To evaluate the effect of ilioinguinal neurectomy versus nerve preservation on the incidence and severity of chronic groin pain following Lichtenstein tension-free mesh hernioplasty for inguinal hernia.

Patients and Methods: This prospective study was conducted on 100 patients with inguinal hernias who underwent Lichtenstein tension-free mesh hernioplasty. They were divided randomly into 2 equal groups; ilioinguinal neurectomy group (A) and nerve preservation group (B). There was no significant difference in patients of both groups regarding age, type of the hernia, precipitating factors, or type of anesthesia. Follow-up of postoperative groin pain was done at1st and 7th POD and after 1, 3, and 6 months during rest as well as after minor exercises using NRS.

Results: The Incidence of postoperative groin pain was significantly lower in the neurectomy group than the preservation group in all follow-up periods.

Conclusion: Resection of ilioinguinal nerve during inguinal hernia repair reduces significantly the incidence of postoperative chronic pain.