Publication:

Prophylactic ilio-inguinal neurectomy following Lichtenstein tension free hernioplasty for inguinal hernia: a prospective study

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 preservation: 35.8±11.9 years and nerve excision group: 42.7±9.6 years). Postoperative pain significantly decreased in group B at POD 3 (65.5% vs. 89.7%, p=0.01) and 3 months (0% vs. 24.1%, p=0.003) when compared to group A. Prevalence of numbness reduced significantly in group A at 3 month (44.8% vs. 86.2%, p=0.001). Although post-operative hypo aesthesia was comparable between the groups at POD 3 (84.6% vs. 78.1%), it decreased significantly in group A at 3 months (27.6 % vs. 86.2%, p<0.001) when compared to group B.

Conclusions Prophylactic excision of ilio-inguinal nerve during Lichtenstein mesh hernia repair decreases the incidence of chronic groin pain after surgery, without additional morbidities.