Prophylactic ilio-inguinal neurectomy in open inguinal hernia repair

Abstract

Objective: To evaluate the eff ect of ilio-inguinal neurectomy on chronic inguinodynia aft er Lichtenstein technique of hernia repair. Study design: Randomized controlled trial Place and duration of study: Surgical ward, Jinnah Postgradute Medical Centre, Karachi from January 2018 to December 2018. Material and Methods: 60 patients of unilateral inguinal hernia were randomly allocated in two groups, group-A (patients having prophylactic ilio-inguinal neurectomy) and group-B (patients having ilioinguinal nerve preservation). Th e method of using visual analogue scale was explained to the patients pre-operatively with end points as ‘no pain’ and ‘worst pain’. Results: Th e mean pain scores experienced aft er various activities of daily living including cycling, climbing stairs and aft er coughing were taken on VAS were almost the same between the 2 groups except that mean pain score was signifi cantly reduced at rest in nerve excision group which was 0.0_0.0 (range 0) p=0.02. Mean pain score(VAS) was signifi cant only at rest all the time(at 1st,3rd and 6th month) with high scores when nerve was preserved (group-B) as compared to when nerve was cut (group-A) Mean pain score (VAS) was signifi cantly higher when climbing stairs at 6th month with when nerve was preserved (group-B) as compared to when nerve was cut (group-A). However the severity scores when compared between two groups on VAS (0-10) showed less severe pain scores in group-A (ilio-inguinal neurectomy) than in patients of nerve preservation. Conclusion: Prophylactic neurectomy of ilio-inguinal nerve may be considered for routine incorporation as a surgical step during open mesh hernia repair however it only reduces chronic pain on rest signifi cantly not on exertion and activity.