Prophylactic ilioinguinal neurectomy in open inguinal hernia repair: a randomized control trial

Belagali, Hareesh; Dandinarasaiah, Manjunath; Devani, Ravindra; Radhakrishna, Veerabhadra

doi:10.18203/2349-2902.isj20180800

Cited by 3 publications

(3 citation statements)

References 7 publications

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“…For the remaining 31 studies, the full texts were obtained and reviewed. Sixteen studies were included [28–43], and 15 studies were excluded from the meta‐analysis (three were not randomized [44–46], six RCTs performed a short follow‐up [47–52], in three RCTs the timing of the follow‐up was different from 6 and 12 months [53–55], two RCTs used the sutureless Trabucco technique [56, 57], and one RCT analyzed the neurectomy of the iliohypogastric nerve [58]).…”

Section: Resultsmentioning

confidence: 99%

Ilioinguinal Nerve Neurectomy is better than Preservation in Lichtenstein Hernia Repair: A Systematic Literature Review and Meta‐analysis

et al. 2021

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Objective This study aimed to evaluate the incidence of chronic groin pain (primary outcome) and alterations of sensitivity (secondary outcome) after Lichtenstein inguinal hernia repair, comparing neurectomy with ilioinguinal nerve preservation surgery. Summary background data The exact cause of chronic groin postoperative pain after mesh inguinal hernia repair is usually unclear. Section of the ilioinguinal nerve (neurectomy) may reduce postoperative chronic pain. Methods We followed PRISMA guidelines to identify randomized studies reporting comparative outcomes of neurectomy versus ilioinguinal nerve preservation surgery during Lichtenstein hernia repairs. Studies were identified by searching in PubMed, Scopus, and Web of Science from April 2020. The protocol for this systematic review and meta-analysis was submitted and accepted from PROSPERO: CRD420201610. Results In this systematic review and meta-analysis, 16 RCTs were included and 1550 patients were evaluated: 756 patients underwent neurectomy (neurectomy group) vs 794 patients underwent ilioinguinal nerve preservation surgery (nerve preservation group). All included studies analyzed Lichtenstein hernia repair. The majority of the new studies and data comes from a relatively narrow geographic region; other bias of this meta-analysis is the suitability of pooling data for many of these studies. A statistically significant percentage of patients with prosthetic inguinal hernia repair had reduced groin pain at 6 months after surgery at 8.94% (38/425) in the neurectomy group versus 25.11% (113/450) in the nerve preservation group [relative risk (RR) 0.39, 95% confidence interval (CI) 0.28–0.54; Z = 5.60 (P < 0.00001)]. Neurectomy did not significantly increase the groin paresthesia 6 months after surgery at 8.5% (30/353) in the neurectomy group versus 4.5% (17/373) in the nerve preservation group [RR 1.62, 95% CI 0.94–2.80; Z = 1.74 (P = 0.08)]. At 12 months after surgery, there is no advantage of neurectomy over chronic groin pain; no significant differences were found in the 12-month postoperative groin pain rate at 9% (9/100) in the neurectomy group versus 17.85% (20/112) in the inguinal nerve preservation group [RR 0.50, 95% CI 0.24–1.05; Z = 1.83 (P = 0.07)]. One study (115 patients) reported data about paresthesia at 12 months after surgery (7.27%, 4/55 in neurectomy group vs. 5%, 3/60 in nerve preservation group) and results were not significantly different between the two groups [RR 1.45, 95% CI 0.34, 6.21;Z = 0.51 (P = 0.61)]. The subgroup analysis of the studies that identified the IIN showed a significant reduction of the 6th month evaluation of pain in both groups and confirmed the same trend in favor of neurectomy reported in the previous overall analysis: statistically significant reduction of pain 6 months after surgery at 3.79% (6/158) in the neurectomy group versus 14.6% (26/178) in the nerve preservation group [RR 0.28, 95% CI 0.13–0.63; Z = 3.10 (P = 0.002)]. Conclusion Ilioinguinal nerve identification in Lichtenstein inguinal hernia repair is the fundamental step to reduce or avoid postoperative pain. Prophylactic ilioinguinal nerve neurectomy seems to offer some advantages concerning pain in the first 6th month postoperative period, although it might be possible that the small number of cases contributed to the insignificancy regarding paresthesia and hypoesthesia. Nowadays, prudent surgeons should discuss with patients and their families the uncertain benefits and the potential risks of neurectomy before performing the hernioplasty.

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Section: Resultsmentioning

confidence: 99%

Ilioinguinal Nerve Neurectomy is better than Preservation in Lichtenstein Hernia Repair: A Systematic Literature Review and Meta‐analysis

et al. 2021

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“…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. Belagali et al(2018) [19] in their study of 60 patients with 30 patients each in nerve excision group and nerve preservation group found during vigorous activities, more group B patients had pain compared to group A patients at 4-month [5 (17%) vs. 15 (50%); p=0.006; Chisquare test] and 8-month follow-up [4 (13%) v/s 11 (37%) ;p=0.04] However, these results were not confirmed in a recent randomized controlled trial by Picchio et al [8] , who found similar incidence of chronic groin pain between ilioinguinal nerve excision group versus nerve preservation. Much controversy exists regarding which treatment to be followed for the inguinal nerves during hernia repair.…”

Section: Jmscr Vol||07||issue||03||page 704-710||march 2019mentioning

confidence: 99%

A Study on Effect of Routine Resection of Illioinguinal Nerve during Repair of Iguinal Hernia

Sethy¹

2019

jmscr

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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.

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“…For the remaining 31 studies, the full texts were obtained and reviewed. Sixteen studies were included [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43], and 15 studies were excluded from the meta-analysis (three were not randomized [44][45][46], six RCTs performed a short follow-up [47][48][49][50][51][52], in three RCTs the timing of the follow-up was different from 6 and 12 months [53][54][55], two RCTs used the sutureless Trabucco technique [56,57], and one RCT analyzed the neurectomy of the iliohypogastric nerve [58]).…”

Section: Trial Identificationmentioning

confidence: 99%

Authors’ Reply: Ilioinguinal Nerve Neurectomy is better than Preservation in Lichtenstein Hernia Repair: A Systematic Literature Review and Meta‐analysis

et al. 2021

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Objective This study aimed to evaluate the incidence of chronic groin pain (primary outcome) and alterations of sensitivity (secondary outcome) after Lichtenstein inguinal hernia repair, comparing neurectomy with ilioinguinal nerve preservation surgery. Summary background data The exact cause of chronic groin postoperative pain after mesh inguinal hernia repair is usually unclear. Section of the ilioinguinal nerve (neurectomy) may reduce postoperative chronic pain. Methods We followed PRISMA guidelines to identify randomized studies reporting comparative outcomes of neurectomy versus ilioinguinal nerve preservation surgery during Lichtenstein hernia repairs. Studies were identified by searching in PubMed, Scopus, and Web of Science from April 2020. The protocol for this systematic review and meta-analysis was submitted and accepted from PROSPERO: CRD420201610. Results In this systematic review and meta-analysis, 16 RCTs were included and 1550 patients were evaluated: 756 patients underwent neurectomy (neurectomy group) vs 794 patients underwent ilioinguinal nerve preservation surgery (nerve preservation group). All included studies analyzed Lichtenstein hernia repair. The majority of the new studies and data comes from a relatively narrow geographic region; other bias of this meta-analysis is the suitability of pooling data for many of these studies. A statistically significant percentage of patients with prosthetic inguinal hernia repair had reduced groin pain at 6 months after surgery at 8.94% (38/425) in the neurectomy group versus 25.11% (113/450) in the nerve preservation group [relative risk (RR) 0.39, 95% confidence interval (CI) 0.28-0.54; Z = 5.60 (P \ 0.00001)]. Neurectomy did not significantly increase the groin paresthesia 6 months after surgery at 8.5% (30/353) in the neurectomy group versus 4.5% (17/373) in the nerve preservation group [RR 1.62, 95% CI 0.94-2.80; Z = 1.74 (P = 0.08)]. At 12 months after surgery, there is no advantage of neurectomy over chronic groin pain; no significant differences were found in the 12-month postoperative groin pain rate at 9% (9/100) in the neurectomy group versus 17.85% (20/112) in the inguinal nerve preservation group [RR 0.50, 95% CI 0.24-1.05; Z = 1.83 (P = 0.07)]. One study (115 patients) reported data about paresthesia at 12 months after surgery (7.27%, 4/55 in neurectomy group vs. 5%, 3/60 in nerve preservation group) and results were not significantly different between the two groups [RR 1.45, 95% CI 0.34, 6.21;Z = 0.51 (P = 0.61)]. The subgroup analysis of the studies that identified the IIN showed a significant reduction of the 6th month evaluation of pain in both groups and confirmed the same trend in favor of neurectomy reported in the previous overall analysis: statistically significant reduction of pain 6 months after surgery at 3.79% (6/158) in the neurectomy group versus 14.6% (26/178) in the nerve preservation group [RR 0.28, 95% CI 0.13-0.63; Z = 3.10 (P = 0.002)]. Conclusion Ilioinguinal nerve identification in Lichtenstein inguinal hernia repair...

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Prophylactic ilioinguinal neurectomy in open inguinal hernia repair: a randomized control trial

Cited by 3 publications

References 7 publications

Ilioinguinal Nerve Neurectomy is better than Preservation in Lichtenstein Hernia Repair: A Systematic Literature Review and Meta‐analysis

Ilioinguinal Nerve Neurectomy is better than Preservation in Lichtenstein Hernia Repair: A Systematic Literature Review and Meta‐analysis

A Study on Effect of Routine Resection of Illioinguinal Nerve during Repair of Iguinal Hernia

Authors’ Reply: Ilioinguinal Nerve Neurectomy is better than Preservation in Lichtenstein Hernia Repair: A Systematic Literature Review and Meta‐analysis

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