Neurectomy in Mesh Repair of Inguinal Hernia; to Reduce Inguinodynia| Chapter 19 | Issues and Developments in Medicine and Medical Research Vol.10

 Introduction: For Lichtenstein inguinal hernia repair, the incidence of long-term (one-year) post-operative neuralgia ranges from 6 to 29 percent. Routine ilioinguinal nerve excision has been suggested as a way to avoid the bothersome complication of long-term postherniorrhaphy neuralgia. Excision of the ilioinguinal nerve should theoretically reduce the risk of inflammatory neuralgia due to entrapment, neuroma, and fibrotic responses, but there are still concerns and the treatment is not universally approved.

Materials and Procedures: A total of 100 patients with inguinal hernia who were hospitalised to a Tertiary care hospital in North Karnataka and were candidates for elective open mesh repair were enrolled and divided into two groups: Group A, where the nerve was preserved, and Group B, where the nerve was removed.
All of the patients had the same procedure: Lichtenstein Tension Free Mesh Repair. On day 1, day 3, day 7, and one month after surgery, I personally followed up. Follow-up is done personally and over the phone at 3 months and 6 months.
The incidence of post-operative groyne pain was compared in patients who had the ilioinguinal nerve preserved against those who had the ilioinguinal nerve removed routinely. Severe pain was found to be 36 percent vs. 6 percent at POD-1, moderate pain 94 percent vs. 22 percent at POD-3, moderate pain 78 percent vs. 10 percent at POD-7, and no pain 8 percent vs. 35 percent in the two groups after one month following surgery. After 3 months of surgery, 32 percent vs. 96 percent reported no pain, and after 6 months of surgery, 68 percent vs. 76 percent reported no pain (16 patients missed the follow-up). In the ilioinguinal nerve preservation group, the incidence of postoperative hyperaesthesia at the groyne was 10%, 14%, and 6% at POD-1, POD-3, and POD-7, respectively. After one month, three months, and six months, no hyperesthesia was seen. In the neurectomy group, there was no evidence of hyperesthesia. At all post-operative follow-ups, the difference in the incidence of post-operative hypoesthesia and groyne numbness between the two groups was determined to be non-significant.
Conclusion: In the current prospective comparison analysis, the neurectomy group had a lower incidence of chronic groyne discomfort after surgery.
Furthermore, other morbidities like as hyperaesthesia, hypoesthesia, and numbness are not significantly related with the surgery.

Author(s) Details:

Associate Professor, S. Y. Mulkipatil
 Department of General Surgery, KIMS, Hubli, Karnataka, India.

S. B. Kuntoji,
Department of General Surgery, SNMC, Bagalkot, Karnataka, India.

Please see the link here:  https://stm.bookpi.org/IDMMR-V10/article/view/5834