Preservation Versus Division of Ilioinguinal Nerve on Open Mesh Repair of Inguinal Hernia: A Meta-analysis of Randomized Controlled Trials.
ABSTRACT Chronic groin pain after inguinal hernia repair, a serious problem, is caused by entrapment of the ilioinguinal nerve either by mesh or development of fibrosis. Division of the ilioinguinal nerve during hernioplasty has been found to reduce the incidence of chronic groin pain. However, the traditional approach favors preservation of the ilioinguinal nerve during open hernia repair.
We conducted a systematic review and meta-analysis of randomized controlled trials that compared the outcomes of preservation versus division of the ilioinguinal nerve during open mesh repair of inguinal hernia. The primary outcome was the incidence of groin pain; secondary outcomes were numbness and sensory loss.
We reviewed six trials with 1,286 patients. We found no difference between the groups for the incidence of groin pain or numbness at 1, 6, and 12 months after open mesh inguinal repair. The incidence of sensory loss or change was significantly higher in the division group than in the preservation group at 6 months [risk ratio (RR) 1.25; 95 % confidence interval (CI) 1.02-1.53] and at 12 months (RR 1.55; 95 % CI 1.01-2.37) postoperatively. No significant differences between the groups were noted at any other points in time.
Preservation of the ilioinguinal nerve during open mesh repair of inguinal hernia is associated with a decreased incidence of sensory loss at 6 and 12 months postoperatively compared with that of the division technique. No significant differences were found between the groups for chronic groin pain or numbness.
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ABSTRACT: During the past 8 years, a total of 36 patients were diagnosed as having either ilioinguinal or genitofemoral neuralgia. A multidisciplinary approach (surgeon, neurologist, anesthesiologist) as well as local blocks of the ilioinguinal nerve or paravertebral blocks of L1,2 were essential to determine which nerve was likely to be entrapped. Seventeen of the 19 patients having a diagnosis of ilioinguinal neuralgia after previous inguinal herniorraphy were completely free of pain after resection of the entrapped portion of the nerve. Seventeen patients were diagnosed as having genitofemoral neuralgia after previous inguinal herniorraphy, blunt abdominal trauma, or another operation. Neurectomy of the genitofemoral nerve proximal to the entrapment controlled the persistent pain in 12 of 17 of these patients. Ilioinguinal or genitofemoral nerve entrapment neuralgias are rare complications of operations in the inguinal region. When the diagnosis is made by a multidisciplinary approach, neurectomy is frequently successful in relieving severe pain and paresthesias without serious morbidity.En los ltimos 8 aos hemos tenido 36 pacientes en quienes se ha diagnosticado neuralgia ilioinguinal o genitofemoral. El enfoque multidisciplinario (cirujano, neurlogo, anestesilogo), as como la realizacin de bloqueos locales del nervio ilioinguinal o de bloqueos paravertebrales de L1,2 fueron esenciales para determinar cual o cuales eran los nervios posiblemente atrapados. Diecisiete de 19 pacientes con el diagnstico de neuralgia ilioinguinal consecutiva a herniprrafia inguinal fueron totalmente liberados de su dolor despus de la reseccin de la porcin afectada por atrapamiento del nervio. En diecisiete pacientes se estableci el diagnstico de neuralgia consecutiva a herniorrafia inguinal, a trauma abdominal cerrado, y a otras operaciones; la neurectoma del nervio genitofemoral proximal al sitio de atrapamiento logr controlar dolor persistente en 12 de estos 17 pacientes. Las neuralgias por atrapamiento de los nervios ilioinguinal y genitofemoral son complicaciones raras de operaciones sobre la regin inguinal. Cuando el diagnstico ha sido establecido mediante enfoque multidisciplinario, la neurectoma es generalmente exitosa en cuanto a controlar el dolor severo y las parestesias, sin estar asociada con morbidad seria.Au cours des 8 dernires annes, on a fait le diagnostic de nvralgie gnitocrurale ou abdominognitale chez 36 patients. Une approche multidisciplinaire (chirurgien, neurologue, et anesthsiste) et l'utilisation de blocs nerveux L1,2, sont 2 facteurs essentiels dans la dtermination du nerf le plus vraisemblablement intress. Dix-sept des 19 patients ayant une nvralgie abdominognitale aprs cure de hernie inguinale ont t soulags par la rsection du nerf pig. Dix-sept patients avaient une nvralgie gnitocrurale la suite d'une cure paritale pour hernie inguinale, un traumatisme abdominal ferm, ou une autre intervention. La rsection nerveuse du nerf gnitocrural en amont de la zone intresse n'a t suivie de succs que chez 12 des 17 patients. La nvralgie abdominognitale ou gnitocrurale est une complication rare de la cure de hernie inguinale. Lorsque le diagnostic est fait par une quipe multidisciplinaire, la rsection nerveuse est souvent suivie de soulagement de la douleur et de paresthsies sans morbidit excessive.World Journal of Surgery 08/1989; 13(5):586-591. · 2.23 Impact Factor
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ABSTRACT: Our study aimed to evaluate the effect of preservation or elective division of the ilioinguinal nerve on pain and postoperative symptoms after open inguinal hernia repair with mesh. Double-blind, randomized trial. Four public, government-financed hospitals in Italy. From January 1, 1997, to June 30, 2002, 813 patients with primary inguinal hernia were randomly allocated to undergo inguinal hernia repair either with ilioinguinal nerve preservation (408 patients, group A) or elective transection (405 patients, group B). Hernia repair with sutureless apposition of a polypropylene mesh. The primary outcome was the evaluation of chronic pain 1 year after operation. Secondary outcomes were postoperative symptoms assessment at 1 week and 1, 6, and 12 months after operation. Telephone interview was performed 35.5 months (range, 12-59 months) after operation to assess the presence of chronic pain. Of the 302 group A and 291 group B patients who made an office visit 1 year postoperatively, pain was absent in 231 (76.5%) and 213 (73%) (difference, 3.30%; 95% confidence interval, -3.68% to 10.28%), mild in 55 (18%) and 60 (21%), moderate in 11 (4%) and 9 (3%), and severe in 5 (2%) and 9 (3%), respectively (P =.55; Pearson chi2(3) test). At 1-month and 6-month follow-up visits, no difference was found between the 2 groups with respect to pain, but loss of pain or touch sensation were significantly greater when the ilioinguinal nerve was divided. One year after operation, the 2 groups were also comparable with respect to loss of pain sensation, but touch sensation remained decreased in group B. At telephone interview, the presence of chronic pain was similar in both groups. Pain after open hernia repair with polypropylene mesh is not affected by elective division of the ilioinguinal nerve; sensory disturbances in the area of distribution of the transected nerve are significantly increased.Archives of Surgery 08/2004; 139(7):755-8; discussion 759. · 4.10 Impact Factor
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ABSTRACT: We conducted a double-blinded randomized controlled trial to investigate the short- to mid-term neurosensory effect of prophylactic ilioinguinal neurectomy during Lichtenstein repair of inguinal hernia. One hundred male patients between the age of 18 and 80 years with unilateral inguinal hernia undergoing Lichtenstein hernia repair were randomized to receive either prophylactic ilioinguinal neurectomy (group A) or ilioinguinal nerve preservation (group B) during operation. All operations were performed by surgeons specialized in hernia repair under local anesthesia or general anesthesia. The primary outcome was the incidence of chronic groin pain at 6 months. Secondary outcomes included incidence of groin numbness, postoperative sensory loss or change at the groin region, and quality of life measurement assessed by SF-36 questionnaire at 6 months. All follow-up and outcome measures were carried out by a designated occupational therapist at 1 and 6 months following surgery in a double-blinded manner. The incidence of chronic groin pain at 6 months was significantly lower in group A than group B (8% vs. 28.6%; P = 0.008). No significant intergroup differences were found regarding the incidence of groin numbness, postoperative sensory loss or changes at the groin region, and quality of life measurement at 6 months after the operation. Prophylactic ilioinguinal neurectomy significantly decreases the incidence of chronic groin pain after Lichtenstein hernia repair without added morbidities. It should be considered as a routine surgical step during the operation.Annals of Surgery 08/2006; 244(1):27-33. · 6.33 Impact Factor