Title: A Comparative Study of Prophylactic Neurectomy and Nerve Preservation in open Inguinal Hernia Repair
Authors: Dr Hafiz Kalam Uddin, Dr Md Anisur Rahman, Dr Samar, Dr Md Akbar Khan
DOI: https://dx.doi.org/10.18535/jmscr/v11i4.20
Abstract
Background: Chronic post operative groin pain is a significant complication following inguinal hernial repair. Recently, with more attention to patient outcomes, chronic groin pain has replaced recurrence as the primary complication after open inguinal hernia repair and has emerged as a common and sometimes severe problem that can significantly affect a patient’s, health-related, quality of life. Chronic groin pain can be classified into neuropathic and nociceptive (somatic) pain. Neuropathic pain is caused due to entrapment or direct nerve injury. Nociceptive (somatic) pain is caused by mesh-related fibrosis, mechanical pressure caused by a folded mesh and etcetera. Traditionally, surgeons opt to preserve the nerves at all times during repair because the nerve injury is often associated with cutaneous sensory loss and chronic groin pain. On the contrary, elective division of the nerves to reduce the incidence of chronic post operative pain has been recommended. Recently reported randomized controlled trials have confirmed the benefits of neurectomy in chronic post op pain.
In our institution, open inguinal hernia repair is one of the most common surgeries performed. This study aims at evaluating the long-term outcomes of neuralgia and paraesthesia following routine nerves excision, compared to nerve preservation.
Aims and Objective
To compare and correlate the therapeutic effectiveness of neurectomy versus nerve preservation with respect to - Post operative groin pain.
-Post operative par aesthesia.
- Post operative patient satisfaction and wellbeing.
Materials and Methods: The present study is a randomized study of cases of inguinal hernias admitted in Katihar Medical College Katihar, during the study period of January 2021 to August 2022. 50 cases for the purpose of the study were selected on the basis of the random sampling method and after taking valid inform consent.
Patients with inguinal hernia underwent open hernia repair were with either prophylactic triple neurectomy (group A) or nerve preservation (group B) during operation. All operations were performed by surgeons specialized in hernia repair under local anaesthesia or spinal anaesthesia. The primary outcome was the incidence of chronic groin pain at 6 months. Secondary outcomes included incidence of groin numbness, postoperative sensory loss or change at the groin region, and quality of life measurement. All follow-up and outcome measures were carried out at 1and 6 months following surgery.
Results: The incidence of chronic groin pain at 6 months was significantly lower in group A than group B. No significant intergroup differences were found regarding the incidence of groin numbness, postoperative sensory loss or changes at the groin region, and quality of life measurement at 6 months after the operation.
Conclusions: Prophylactic neurectomy significantly decreases the incidence of chronic groin pain after open hernia repair without added morbidities. It should be considered as a routine surgical step during the operation
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