Comparative Study of Preservation Versus Division of Ilioinguinal Nerve during Lichtenstein Mesh Hernioplasty in Southern Odisha.

Dr Manoj Kumar Sethy; Dr Sangram Bal; Dr Ambuja Satpathy; Dr Amar Kumar Behera; Dr Biswa Ranjan Pattnaik

Volume : VII, Issue : XI, November - 2018

Comparative Study of Preservation Versus Division of Ilioinguinal Nerve during Lichtenstein Mesh Hernioplasty in Southern Odisha.

Dr Manoj Kumar Sethy, Dr Sangram Bal, Dr Ambuja Satpathy, Dr Amar Kumar Behera, Dr Biswa Ranjan Pattnaik

Abstract :

Background: Hernias are among the oldest known afflictions of humankind and surgical repair of inguinal hernias are among the most common general surgical procedures performed today.¹ Despite the high incidence, the technical aspects of hernia repair continue to evolve. Chronic pain is defined as “pain lasting for more than 3 months” as per the International Association for the Study of Pain.²Chronic post herniorrhaphy groin pain is defined as pain lasting for more than 3 months after surgery. It is one of the most important complications occurring after inguinal hernia repair and it occurs with greater frequency than previously thought. Majority of chronic pain has been attributed to Ilioinguinal nerve entrapment. Routine excision of the ilioinguinal nerve is an attempt to decrease the incidence of chronic groin pain caused by nerve entrapment, inflammation and fiotic reactions around the nerve.

AIMS AND OBJECTIVES:The purpose of the current study is to evaluate the effect of routine ilioinguinal nerve excision compared to nerve preservation on chronic groin pain, paraesthesia and also on the quality of life when performing Lichtenstein tension free inguinal hernia repair.

Method: A total of 100 patients admitted for inguinal hernia at M.K.C.G. Medical College & Hospital Berhampur who met with the inclusion criteria underwent open mesh repair of inguinal hernia over the study period from August 2016 to August 2018.The ilioinguinal nerve was identified and preserved in 50 patients(group A) and elective division of the ilioinguinal nerve was done in 50 patients(group–B). The primary outcome was the incidence of chronic groin pain at the end of 1 month, 3 months and 6 months following the procedure. Secondary outcomes included incidence of postoperative sensory loss or sensory change at the groin region and quality of life measurement assessed by modified SF–36 questionnaire at the end of 6 months.

Results: About 93 out of 100 patients completed the study protocol fully. The incidence of post–operative groin pain at rest in this study compared ilioinguinal nerve preservation versus routine excision of ilioinguinal nerve showing was 8% versus 6% at 1 month, 8.33% versus 2.05% at 3 months, and 8.52% versus 2.18% at 6 months. The incidence of post–operative groin pain during Normal Daily Activities in this study compared ilioinguinal nerve preservation versus routine excision of ilioinguinal nerve showing was 10% versus 8% at 1 month, 8.33% versus 2.05% at 3 months, and 8.52% versus 2.18% at 6 months. The incidence of post–operative groin pain after Moderate Activities in this study compared ilioinguinal nerve preservation versus routine excision of ilioinguinal nerve showing was 14% versus 12% at 1 month, 8.33% versus 2.05% at 3 months, and 8.52% versus 2.18% at 6 months. The incidence of post–operative groin pain after Vigorous Activity in this study compared ilioinguinal nerve preservation versus routine excision of ilioinguinal nerve showing was 58% versus 48% at 1 month, 50% versus 12.25% at 3 months, and 51.07% versus 10.87% at 6 months. The incidence of post–operative groin pain on Walking in this study compared ilioinguinal nerve preservation versus routine excision of ilioinguinal nerve showing was 30% versus 18% at 1 month, 27.09% versus 2.05% at 3 months, and 21.28% versus 2.18% at 6 months. The incidence of Post Operative hypoaesthesia in this study compared ilioinguinal nerve preservation versus routine excision of ilioinguinal nerve showing was 10% versus 20% at 1 month, and 4.2% versus 18.4% at 3 months , 4.3% versus 13.05% at 6 months. The incidence of post–operative Hyperesthesia compared ilioinguinal nerve preservation versus nerve excision results showed 26% versus 20% at 1 month, 4.17% versus 8.2% at 3 months and 4.26 versus 0% at 6 months.

Conclusion: The prophylactic excision of the ilioinguinal nerve during Lichtenstein mesh hernia repair decreases the incidence of chronic groin pain after surgery. Furthermore the procedure is not significantly associated with additional morbidities in terms of local cutaneous neurosensory disturbances. So when performing Lichtenstein inguinal hernia repair, routine ilioinguinal neurectomy is a reasonable option.