Abstract
Introduction: Chronic pain following Lichtenstein repair of inguinal hernia surgery has incidence of 6 - 29% and has emerged as a common and sometimes severe problem that can significantly affect a patient’s health-related quality of life. It occurs due to entrapment, ligation, neuroma or fibrotic reactions involving any of the nerves at inguinal region of which the ilioinguinal nerve is most commonly involved. Though the excision of ilioinguinal nerve should theoretically eliminate the possibility of inguinal neuralgia, this concept of routine ilioinguinal nerve excision in inguinal hernia repairs is not well accepted. The present study was done with the aim to compare and correlate the therapeutic effectiveness of routine ilioinguinal neurectomyin chronic inguinodynia.
Materials and Methods: A total of 50 patients were admitted or primary inguinal hernia repair (unilateral or bilateral), satisfying all the inclusion criteria in the study. All patients were treated with Lichtenstein tension-free hernioplasty with polypropelene mesh. In one group of 25 patients, i.e (Group-A) Ilioinguinal nerve was identified and excised. In another group of 25 patients i.e. (Group-B) ilioinguinal nerve preserved. Post-operative assessment for chronic groin pain and numbness was carried out at 1 month, 6 month and 1 year. At the end of the study both the group of patients i.e. nerve excision group (group-A) and nerve preservation group (group-B) were compared forincidence of post-herniorrhaphy groin pain & post herniorrhaphy groin numbness.
Observations: This prospective study showed a satisfactory decrease in the incidence of post-operative groin pain at 1 month, 6 months and 1 year, for patients in the ilioinguinal nerve excision group versus nerve preservation group. This study also clearly demonstrated that, elective excision of ilioinguinal nerve is not accompanied by a significant increase in post-operative groin numbness.
Conclusion: The result of this prospective trial demonstrates that prophylactic excision of ilioinguinal nerve during Lichtenstein tension free hernioplasty significantly decreases the incidence of chronic groin pain and not associated with additional morbidities in terms of local cutaneous neurosensory disturbances and ilioinguinal neurectomy should be considered as a routine surgical step during open mesh hernia repairs.
References
- Townsend Jr CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery. 19th. Ch 55.
- Nienhuijs S, Staal E, Strobbe L, Rosman C, Groenewoud H, Bleichrodt R. Chronic pain after mesh repair of inguinal hernia: a systematic review. The American journal of surgery. 2007 Sep 1;194(3):394-400.
- 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.
- Fisher JE, Amid PK, Chen C. Postherniorrhaphy inguinodynia: causes, prevention, and surgical treatment: triple neurectomy. In: Fischer JE. Fisher’s Mastery of Surgery. 6th Edition. Lippcott Williams and Wilkins. South Asian: 2012;21482153.
- Poobalan AS, Bruce J, Smith WC, King PM, Krukowski ZH, Chambers WA. A review of chronic pain after inguinal herniorrhaphy. The Clinical journal of pain. 2003 Jan 1;19(1):48-54.
- Geis WP, Sing K, Gillion GK. An Algorithm for the treatment of chronic pain after inguinal. Herniorrhaphy. 2002;307-16.
- Cunningham W, Temple J, Mitchell P. Co-operative hernia study: pain in the post-surgical patient. Am J Surg. 1996;224:598-02.
- Picchio M, Marcello P, Palimento D. RCT of preservation or elective division of ilio inguinal nerve on open mesh repair. Arch Surg. 2004;139:755-8.
- Poobalan AS, Bruce J, King PM. Chambers WA, Krukowski ZH, Smith WC Chronic pain and quality of life following open inguinal hernia repair. Br.JSurg 2001 Aug; 88 (8) 1122-6.
- Bay-Nielsen M, Nilsson E, Nordin P, Kehlet H, Chronic Pain after open mesh & Sutured repair of indirect inguinal hernia in young males. Br J Surg. 2004 Oct; 91(10): 1372-6.
- Alfieris, Rotandi F, Diicelid et al. Chronic pain after inguinal hernias meslmulticentric study of 973 cases. Chir ital. 2006 Jan-Feb; 58 (1) : 23-31.
- Dennis R, O'riordan D. Risk factors for chronic pain after inguinal hernia repair. The Annals of The Royal College of Surgeons of England. 2007 Apr;89(3):218-20.
- Courtney CA, Duffy K, Serpell MG, O'dwyer PJ. Outcome of patients with severe chronic pain following repair of groin hernia. British Journal of Surgery. 2002 Oct 1;89(10):1310-4.
- Ravichandran D, Kalambe BG, Pain JA. Pilot randomized controlled study of preservation or division of ilioinguinal nerve in open mesh repair of inguinal hernia. British journal of surgery. 2000 Sep 1;87(9):1166-7.
- Tsakayannis DE, Kiriakopoulos AC, Linos DA. Elective neurectomy during open, “tension free” inguinal hernia repair. Hernia. 2004 Feb 1;8(1):67-9.
- Wantz GE. Testicular atrophy and chronic residual neuralgia as risks of inguinal hernioplasty. Surgical Clinics of North America. 1993 Jun 1;73(3):571-81.
- Bansal A, Rabha S, Griwan M, Karthikeyan Y. Comparative evaluation of preservation versus elective division of the ilioinguinal nerve in open mesh repair of inguinal hernias. The Internet Journal of Surgery. 2013;30(1).
- Mulkipatil SY, Kuntoji SB. Randomized control study of ilio-inguinal nerve preservation versus neurectomy in lichtenstein tension free mesh repair of inguinal hernia. International Surgery Journal. 2016 Dec 13;4(1):209-13.
- Belagali H, Manjunath DA, Devani R, Radhakrishna V. Prophylactic ilioinguinal neurectomy in open inguinal hernia repair: a randomized control trial. International Surgery Journal. 2018 Feb 26;5(3):904-7.
Corresponding Author
Dr Sudarshan Sethy
DOI: https://dx.doi.org/10.18535/jmscr/v7i3.128
