Ilioinguinal nerve preservation vs prophylactic neurectomy in Lichtenstein tension-free mesh hernioplasty of inguinal hernia: a prospective comparative study

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Abstract

Introduction
Chronic groin pain is a significant morbidity following open mesh hernioplasty for inguinal hernia. Although the pain is often mild in nature, different studies have shown that chronic pain, irrespective of severity, can significantly interfere with normal daily activities. Identification and division of the ilioinguinal nerve (IIN) can reduce chronic postoperative inguinal pain as suggested by many authors, yet controversies persist.
Patients and methods
This prospective study was carried out on 240 patients with primary inguinal hernias categorized into two equal groups. Group A patients underwent prophylactic ilioinguinal neurectomy, whereas nerve preservation was done in group B patients during Lichtenstein tension-free mesh hernioplasty for inguinal hernia in the Gastrointestinal and Laparoscopic Surgery Unit, General Surgery Department, Tanta University Hospitals, during the study period (24 months, from January 2017 to December 2018). Follow-up of postoperative groin pain was done on first postoperative day, seventh postoperative day, and after 1, 3, and 6 months using visual analog scale.
Results
The difference between both groups regarding postoperative pain after 6 months at rest was statistically insignificant. However, after minor exercises like coughing 10 times, walking up three flights of stairs, or cycling for 10 min, there was a statistically significant difference, as no pain occurred in group A patients, whereas 30% of group B patients experienced pain (<0.05). The difference between both groups regarding incidence of postoperative sensory changes was statistically insignificant after 6 months of follow-up (>0.05).
Conclusion
Prophylactic ilioinguinal neurectomy may be beneficial in minimizing inguinal neuralgia after mesh hernioplasty of inguinal hernia.

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