A randomised control study on neurosensory outcomes of ilioingunal neurectomy in Lichtenstein's hernia repair

Abstract

Annappa Kudva, Badareesh Lakshminarayana, Pavan Kumar Addala, Prasad Seetharama

Background: Chronic groin pain is a major cause of post-operative morbidity in open inguinal mesh hernia repair. Neurectomy is a well-established treatment modality. This study was performed to evaluate the neurosensory outcomes of prophylactic neurectomy in open mesh hernia repair. Aim: To assess the incidence of inguinodynia in patients undergoing open mesh hernia repair And to study, the neurosensory outcomes of sacrificing the ilioinguinal nerve in comparison to the group in which a nerve is identified and preserved. Materials and methods: A prospective double-blinded study was performed at Kasturba Medical College, Manipal from September 2008 to December 2009. The ilioinguinal nerve was either preserved or sacrificed according to the surgeon’s choosing. Pain and hyposthesia were studied at defined timed intervals by a single observer. Results: 105 inguinal hernia mesh repairs were enrolled into the study. Nerve excision was done in 44 patients and preserved in 61 patients. Ninety patients were followed till six months. At post-operative day 1, all patients in both the groups had pain and 15.2% had numbness. Chronic post surgical inguinodynia was seen in 16.7% of the population in the study group and numbness in 5.6% of the study population at six months. Conclusion: The severity of pain in the neurectomy group was less than the control group. There were no significant differences in the neurosensory outcomes of prophylactic ilioinguinal neurectomies in open mesh hernia repair compared to nerve preservation and hence prophylactic neurectomy is presently the choice of most surgeons