Randomized Controlled Trial of Preservation or Elective Division of Ilioinguinal Nerve on Open Inguinal Hernia Repair With Polypropylene Mesh

Picchio, Marcello; Palimento, Domenico; Attanasio, Ugo; Matarazzo, Pietro Filippo; Bambini, Chiara; Caliendo, Angelo

doi:10.1001/archsurg.139.7.755

Cited by 124 publications

(96 citation statements)

References 14 publications

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“…Picchio [54] (LE 1b; GR ''A'') reports that pain is not affected by elective neurectomy (according to the new nomenclature) of the ilioinguinal nerve, as also reported by Pappalardo [52] for iliohypogastric neurectomy.…”

Section: Hernia (2011) 15:239-249 243mentioning

confidence: 81%

“…In fact, the terms ''division'', ''resection'', ''dissection'', ''transection'', ''section'' and ''neurectomy'' are often used and reported wrongly, influencing and distorting the real results of studies, with important and practical implications regarding the treatment of chronic pain [12]. A clear example of this aspect is, for instance, the incorrect interpretation of Picchio' s paper [54], which is often cited as a study demonstrating that pain is not affected by elective division of the ilioinguinal nerve, whereas, reading the whole paper, it is possible to find out that the author actually performed a neurectomy (dividing the nerve lateral to the internal ring) instead of a simple division of the nerve in the operative field. Consequently, the results of this paper have often been distorted, which may also give the erroneous message that the nerves may be sectioned during operation at any level of the inguinal canal without any consequence [10].…”

Section: Incidence and Terminologymentioning

confidence: 99%

“…Three randomized trials have examined the effect of prophylactic neurectomy on chronic pain, [46,54,57]. In all three trials, the ilioinguinal nerve was either divided or partially resected, and patients were assessed for pain, numbness and touch and pain sensation at 1, 6 and 12 months.…”

Section: Prophylactic Neurectomy To Reduce the Rate Of Post Herniorrhmentioning

confidence: 99%

See 2 more Smart Citations

International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery

Alfieri

Amid

Campanelli

et al. 2011

Hernia

353

234

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Purpose To provide uniform terminology and definition of post-herniorrhaphy groin chronic pain. To give guidelines to the scientific community concerning the prevention and the treatment of chronic groin and testicular pain. Methods A group of nine experts in hernia surgery was created in 2007. The group set up six clinical questions and continued to work on the answers, according to evidencebased literature. In 2008, an International Consensus Conference was held in Rome with the working group, with an audience of 200 participants, with a view to reaching a consensus for each question.

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Section: Hernia (2011) 15:239-249 243mentioning

confidence: 81%

Section: Incidence and Terminologymentioning

confidence: 99%

See 1 more Smart Citation

International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery

Alfieri

Amid

Campanelli

et al. 2011

Hernia

353

234

View full text Add to dashboard Cite

show abstract

“…27 A telephone interview study of patients having elective resection of the iliohypogastric and Ilioinguinal nerves during a tension-free mesh herniorrhaphy (n=191) reported no complaints of postoperative pain. 28,29 No patients reported pain after 1, 6, or 12 months, but 7% of patients complained of numbness or sensory loss after 1 yr. It seems that sensory disturbances are common after inguinal herniorrhaphy and that these patients may be at a higher risk of also having chronic pain 17 Thus, nerve injury after inguinal herniorrhaphy may be a prerequisite for development of chronic pain, although other (unknown) factors must be involved.…”

Section: Clinical Testing At 6 Monthsmentioning

confidence: 99%

A clinical study of the incidence and disability caused by mesh neuralgia after inguinal mesh hernioplasty and the effects of prophylactic ilioinguinal neurectomy and its role in preventing chronic groin pain after inguinal hernioplasty

Sunkar¹,

Brashier²,

Bhagwat³

et al. 2018

Int Surg J

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Background: Residual neuralgia, called as Inguinodynia, is an important complication unique to groin hernia repair. The reported incidence ranges between 9-63%. The symptoms are potentially disabling. Symptoms are often more pronounced on axial twisting of body. Methods for prevention include identification and preservation of all nerves, Ilioinguinal Neurectomy and triple Neurectomy during surgery.Methods: One hundred patients underwent elective unilateral Lichtenstein’s tension free hernioplasty. 50 patients were subjected to elective ilioinguinal neurectomy. The remaining underwent standard Liechtenstein’s mesh hernioplasty, without ilioinguinal neurectomy. Randomization was achieved by allocating alternate patients to each group - prophylactic neurectomy, or nerve preservation. All patients, during each review were asked to fill out a Pain Disability Questionnaire to assess sensory loss and pain disability objectively.Results: At completion of 6 monthly follow up pain at rest (none in group ‘A’ compared with 3 in group ‘B’), after coughing 5 times (none in group ‘A’ compared with 7 in group ‘B’), after climbing 4 flights of stairs(3 in group ‘A’ compared with 16 in group ‘B’) and after cycling for 20 minutes (11 in group ‘A’ compared with 22 in group ‘B’) were all significantly lesser in the neurectomy group as compared with the non neurectomy group. More importantly, exertional chronic pain incidence at 6 months was significantly less in group ‘A’.Conclusions: It was concluded that pain after inguinal mesh hernioplasty is a cause of morbidity, pain was complained of by a significantly larger number of non-neurectomised patients at 6 months of follow-up, prophylactic ilioinguinal neurectomy is associated with reduced exertional chronic groin pain, disability caused by pain after inguinal hernioplasty, is significantly reduced by ilioinguinal neurectomy and an extremely significant reduction in the requirement of medication is brought about by neurectomy compared with controls.

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“…The nerve then pierces the Obliquus internus (distributing filaments to it) just medial to the anterior superior iliac spine, at this point it becomes visible between the external and internal obliques and then it passes into the inguinal canal, accompanying the spermatic cord, through the subcutaneous inguinal ring. [3][4][5] After leaving the superficial inguinal ring, the ilioinguinal nerve subdivides into:…”

Section: Discussionmentioning

confidence: 99%

Ilio inguinal neurectomy in inguinal hernia

et al. 2017

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Background: Inguinal hernia is one of the most common surgery done in any hospital. Chronic inguinal pain is one of the common problem these patients complain of. This study aims at evaluating the long-term outcomes of neuralgia and paraesthesia following routine ilioinguinal nerve division, compared to nerve preservation when performing Lichtenstein’s inguinal hernia repair.Methods: The present study is a randomized controlled trial of 60 cases of inguinal hernias admitted in General Surgery Department in our hospital. The patients were randomly chosen into Lichtenstein hernia repair with ilioinguinal neurectomy or Lichtenstein hernia repair with nerve preservation. After surgery, all patients were monitored carefully for pain and paraesthesia. Pain was assessed using visual analogue scale. Paraesthesia was assessed by the monofilament test and evaluated after comparison with the opposite side.Results: In the present study, the incidence of pain as well as the severity of pain is far higher in the nerve preservation study group as opposed to the neurectomy study group. Hypaesthesia is not a significant complication following ilioinguinal neurectomy and does not significantly add to the morbidity of the patient.Conclusions: Prophylactic neurectomy can be an appropriate solution in the prevention of chronic groin pain following Lichtenstein inguinal hernia repair and can be considered as an ideal inclusion into the standard hernia repair procedures. Hypoesthesia is not a significant complication following ilioinguinal neurectomy and does not significantly add to the morbidity of the patient.

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Randomized Controlled Trial of Preservation or Elective Division of Ilioinguinal Nerve on Open Inguinal Hernia Repair With Polypropylene Mesh

Cited by 124 publications

References 14 publications

International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery

International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery

A clinical study of the incidence and disability caused by mesh neuralgia after inguinal mesh hernioplasty and the effects of prophylactic ilioinguinal neurectomy and its role in preventing chronic groin pain after inguinal hernioplasty

Ilio inguinal neurectomy in inguinal hernia

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