Publication:

Randomized control study of ilio-inguinal nerve preservation versus neurectomy in lichtenstein tension free mesh repair of inguinal hernia

Background Chronic post herniorrhaphy groin pain is defined as pain lasting > 3 months after surgery. Incidence of long term (= 1 year) post-operative neuralgia reported for Lichtenstein repair of inguinal hernia range from 6 - 29%Objective: To evaluate the effect of routine ilioinguinal nerve excision compared to nerve preservation on chronic groin pain and other sensory symptoms when performing lichtenstein inguinal hernia repair.

Methods 100 patients, diagnosed as inguinal hernia and candidate for nonemergency open mesh inguinal hernioplastic repair were enrolled and divided into 2 groups. All patients underwent Lichtenstein tension free mesh repair. Post-operative follow-up was done on day 1, 3, 7, at 1 month, 3 months and 6 months.

Results The incidence of post-operative severe pain was 36% versus 6% at POD-1, moderate pain 94% versus 22% at POD-3, moderate pain 78% versus 10% at POD-7 and no pain 8% versus 35% after 1 month of surgery respectively in the two groups. The incidence of post-operative hyperesthesia at groin in ilioinguinal nerve preservation group was 10%, 14%, 6% and 0% at POD-1, POD- 3, POD-7 and after 1 month respectively. Hyperesthesia was not observed in neurectomy group. Incidence of post-operative hypoesthesia and numbness at groin between the two groups at all post-operative follow up was found to be non-significant.

Conclusions - The study revealed decreased incidence of chronic groin pain after surgery in neurectomy group. The procedure is not significantly associated with additional morbidities like hyperesthesia, hyposthesia and numbness.