Effect of Ilioinguinal Neurectomy on Chronic Pain following Herniorrhaphy

Abstract

BackgroundInguinal hernia is one of the most common male diseases all over the world with an incidence rate of 18-24% throughout life. Chronic inguinal pain is one of the complications that prolong return to work time.ObjectivesThe main aim of this study was to determine the effect of ilioinguinal neurectomy on postoperative chronic pain (PCP) in patients that underwent open inguinal hernia repair via the Lichtenstein method.Materials and MethodsIn this randomised controlled clinical trial, male patients with unilateral inguinal hernia were randomized into two groups: 74 cases in the preserved-nerve group and 66 cases in the nerve-excised group. The method of herniorrhaphy was the classic Lichtenstein method. Pain and numbness were evaluated at 1 day, 1 week, 1 month, 6 months and 1 year after surgery via visual analogue scale (VAS) system. We used SPSS ver.16 for analysis.ResultsAll patients were male with mean age of 39.1 years (with a range of 18 to 68 years). The follow-up rate was 100% after 1 year. Pain severity was significantly lower in nerve-excised patients at 1 day, 1week, 1 month and 6 months after surgery; but it was not significant after one year, although overall pain severity was low. Numbness was significantly higher in excised patients at all endpoints (1 day, 1month, 3 months, 6 months and one year after surgery).ConclusionsIlioinguinal nerve excision at the time of inguinal hernia repair decreased post-surgical inguinal pain, and it can be used as a routine method in herniorrhaphy.

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

“…15 In agreement, other studies have also supported the excision of ilioinguinal nerve. 8,16,17 On the contrary, chronic groin pain between the neurectomy group and controls did not vary in a randomized controlled trial by Picchio et al 18 However, it was also seen that elective neurectomy of the ilioinguinal nerve did not associate with any neurosensory disturbance or groin numbness even at 6-month post follow-up, similar to our study findings. This observation also had supporting data from another study by Hsu et al 18,19 Day We also observed that the incidence of early postoperative pain on day 1 was more significant in neurectomised patients (group B) than in the nerve preserved group.…”

“…20 On the other hand, Malekpour et al, and Khoshmohabat et al, found pain on the 1 st and 7 th post-operative day to be significantly less in the neurectomy group. 8,16 However, in the current study, VAS pain scores at the end of 1 month and 3 months was significantly less in patients having selective ilioinguinal neurectomy as compared to nerve preserved group. Mui et al, found that prophylactic ilioinguinal neurectomy significantly decreased the incidence of chronic groin pain at 6months after Lichtenstein hernia repair without added morbidities.…”

Endoscopic tympanic neurectomy for otic neuralgia—a case series

“…In other areas, a regional neurectomy has been shown to reduce the incidence of neuropathic pain. Examples of this treatment include ilioinguinal neurectomy following chronic neuropathic pain after herniorrhaphy (15)(16)(17) as well as trigeminal neurectomy for trigeminal neuralgia (18). It is proposed that likely an infectious or traumatic insult to the tympanic nerve during middle ear infections can result in the same cascade of neuronal events seen in PHN, with the subsequent division of the nerve removing this perception of otalgia.…”

Remedial robot-assisted laparoscopic surgery in the treatment of neuropathic inguinodynia and repair of inguinal hernia

“…Persistent post-neurectomy pain can result from a variety of surgical complications, including excision of the incorrect nerve, suture entrapment, partial division, crushing, or diathermy of the other non-excised nerves. [15] For example, nerve blocks administered to wrong or unintended nerves could result in a misleading diagnosis (if the pain dissipates) leading to the wrong nerve or branch being excised with resultant persistence of pain postoperatively. [6] This may have been the case in our patient.…”