scholarly journals Prophylactic ilioinguinal neurectomy: Can it prevent chronic groin pain after Lichtenstein inguinal hernia repair?

2016 ◽  
Vol 4 (2) ◽  
pp. 39-44 ◽  
Author(s):  
Arbin Joshi
Keyword(s):  
Chronic Pain ◽  
Inguinal Hernia ◽  
Hernia Repair ◽  
Mesh Repair ◽  
Groin Pain ◽  
Chronic Groin Pain ◽  
Ilioinguinal Nerve ◽  
Nerve Preservation ◽  
Medical College ◽  
Open Mesh Repair

Background: Contrary to the previous belief, division of the ilioinguinal nerve prophylactically during mesh repair has been practiced to reduce the incidence and intensity of persistent postoperative pain after hernia repair. Objectives: To evaluate whether prophylactic ilioinguinal neurectomy prevents chronic groin pain after primary Lichtenstein hernia repair.Methods: Patients undergoing elective open mesh repair of inguinal hernia were randomized in two groups; nerve excision and nerve preservation group by opaque envelope method. Fifty cases were included in each group. A telephone interview was conducted after three months of the surgery. Pain scoring was done with Numeric Pain Intensity Scale and its effect in daily activities was measured with Patient Disability Index.Results: Forty-four patients in excision group and 45 in preservation group satisfied the inclusion criteria. Nine (20%) in the previous group and 16 (34.78%) in the latter group had chronic pain (p=0.113). Mean severity score in patients who had pain was significantly high in preservation group (2.22 versus 3.31, p=0.039). The incidence of scrotal numbness was higher in excision group (20% versus 13.3%, p=0.370).Conclusion: Though insignificant reduction in incidence of chronic groin pain was observed after division of ilioinguinal nerve, significant reduction in the intensity of the chronic pain especially during activities related to home and during self care has been shown.Journal of Kathmandu Medical College, Vol. 4, No. 2, Issue 12, Apr.-Jun., 2015, Page: 39-44

scholarly journals Comparative study of preservation versus elective division of ilioinguinal nerve on chronic groin pain after lichtenstein tension free inguinal hernia repair

2020 ◽  
Vol 7 (5) ◽  
pp. 1503
Author(s):  
Renuka Chaudhary ◽  
M. Salim ◽  
M. Rafik Rao
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Groin Pain ◽  
Chronic Groin Pain ◽  
Ilioinguinal Nerve ◽  
Nerve Preservation ◽  
Group A ◽  
Group B

Background: Post-hernioplasty chronic groin pain is one of the most important complications encountered after inguinal hernia repair. Routine ilioinguinal nerve excision has been proposed to avoid chronic post-hernioplasty neuralgia. The study aimed to evaluate the effect of routine ilioinguinal nerve excision compared to nerve preservation on chronic groin pain and other sensory symptoms in lichtenstein inguinal hernia repair.Methods: The study was conducted in the department of general surgery, at S.P. Medical College and PBM Hospital, Bikaner for duration of 15 months from august 2018 to November 2019. A total of 60 patients of uncomplicated inguinal hernia, who met the inclusion criteria, planned for lichtenstein hernioplasty were randomly divided into 2 groups with 30 cases with ilioinguinal nerve preservation (group A) and 30 cases with elective division of the nerve (group B). Follow up was done upto1 year and patients were inquired regarding pain, hypoesthesia and numbness and data was compared and analysed.Results: The incidence of post-operative neuralgia was 23.33% vs 6.67% (p=0.05) at 1 year in group A and group B respectively. The difference in pain was significant in both groups. The incidence of post-operative hypoesthesia was 10% vs 16.67% (p>0.05) at 1 year follow up in group A and group B respectively. The incidence of numbness was 11.11% vs 16.67% (p>0.05) at 1 year in group A and group B respectively. No statistically significant difference was found in both groups.Conclusions: The prophylactic exicision of ilioinguinal nerve during lichtenstein mesh repair decreases the incidence of chronic groin pain after surgery.

scholarly journals A prospective study comparing preservation of ilioinguinal nerve with neurectomy in open mesh repair of inguinal hernia

2018 ◽  
Vol 6 (1) ◽  
pp. 114
Author(s):  
Probal Neogi ◽  
Santosh Kumar Singh ◽  
Soumitra Manwatkar ◽  
Sunil Kumar Singh ◽  
Abhishek Saxena ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Postoperative Pain ◽  
Mesh Repair ◽  
Groin Pain ◽  
Chronic Groin Pain ◽  
Ilioinguinal Nerve ◽  
Open Mesh Repair ◽  
The Difference ◽  
A Prospective Study ◽  
Open Mesh

Background: Postoperative pain after open mesh repair of inguinal hernia is an important challenge. Such type of pain sometimes does not respond to medical treatment including non-steroidal anti-inflammatory drugs and opiates. The objective of the present study was to evaluate the effect of preservation or division of the Ilioinguinal nerve on pain and post-operative symptoms, after open mesh repair of inguinal hernia.Methods: All patients undergoing surgery for tension free Lichtenstein mesh repair over a period of 1 year were included. Patients below the age of 18 years and patients with bilateral or recurrent hernias were excluded.Results: In present study of 42 patients, early mean postoperative pain at day 1 was 1.8 on VAS scale in ilioinguinal neurectomised patient compared to 1.5 in nerve preserved group (P=0.1408). Postoperative pain at week 1 was 1.25 in neurectomised patients compared to 1.32 in nerve preserved group (P=0.7161). Late Postoperative pain and chronic groin pain was 0.6 and 0.25 at 1 and 3 months respectively in ilioinguinal neurectomised patients as compared to 1.05 and 0.77 at 1 and 3 months respectively in nerve preserved group (P=0.0184 at 1month and P=0.0335 at 3 months).Conclusions: The difference in postoperative pain at day 1 and at week 1 was not significant and both groups had equal pain. Late postoperative pain (at 1 month) and chronic groin pain (at 3 months) was significantly low in ilioinguinal neurectomised patient compared to nerve preserved group.

scholarly journals Ilioinguinal Nerve Neurectomy is better than Preservation in Lichtenstein Hernia Repair: A Systematic Literature Review and Meta-analysis

2021 ◽  
Author(s):  
Roberto Cirocchi ◽  
Marco Sutera ◽  
Piergiorgio Fedeli ◽  
Gabriele Anania ◽  
Piero Covarelli ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Groin Pain ◽  
Meta Analysis ◽  
Group Versus ◽  
Chronic Groin Pain ◽  
Ilioinguinal Nerve ◽  
Nerve Preservation ◽  
Lichtenstein Hernia Repair

Abstract Objective This study aimed to evaluate the incidence of chronic groin pain (primary outcome) and alterations of sensitivity (secondary outcome) after Lichtenstein inguinal hernia repair, comparing neurectomy with ilioinguinal nerve preservation surgery. Summary background data The exact cause of chronic groin postoperative pain after mesh inguinal hernia repair is usually unclear. Section of the ilioinguinal nerve (neurectomy) may reduce postoperative chronic pain. Methods We followed PRISMA guidelines to identify randomized studies reporting comparative outcomes of neurectomy versus ilioinguinal nerve preservation surgery during Lichtenstein hernia repairs. Studies were identified by searching in PubMed, Scopus, and Web of Science from April 2020. The protocol for this systematic review and meta-analysis was submitted and accepted from PROSPERO: CRD420201610. Results In this systematic review and meta-analysis, 16 RCTs were included and 1550 patients were evaluated: 756 patients underwent neurectomy (neurectomy group) vs 794 patients underwent ilioinguinal nerve preservation surgery (nerve preservation group). All included studies analyzed Lichtenstein hernia repair. The majority of the new studies and data comes from a relatively narrow geographic region; other bias of this meta-analysis is the suitability of pooling data for many of these studies. A statistically significant percentage of patients with prosthetic inguinal hernia repair had reduced groin pain at 6 months after surgery at 8.94% (38/425) in the neurectomy group versus 25.11% (113/450) in the nerve preservation group [relative risk (RR) 0.39, 95% confidence interval (CI) 0.28–0.54; Z = 5.60 (P < 0.00001)]. Neurectomy did not significantly increase the groin paresthesia 6 months after surgery at 8.5% (30/353) in the neurectomy group versus 4.5% (17/373) in the nerve preservation group [RR 1.62, 95% CI 0.94–2.80; Z = 1.74 (P = 0.08)]. At 12 months after surgery, there is no advantage of neurectomy over chronic groin pain; no significant differences were found in the 12-month postoperative groin pain rate at 9% (9/100) in the neurectomy group versus 17.85% (20/112) in the inguinal nerve preservation group [RR 0.50, 95% CI 0.24–1.05; Z = 1.83 (P = 0.07)]. One study (115 patients) reported data about paresthesia at 12 months after surgery (7.27%, 4/55 in neurectomy group vs. 5%, 3/60 in nerve preservation group) and results were not significantly different between the two groups [RR 1.45, 95% CI 0.34, 6.21;Z = 0.51 (P = 0.61)]. The subgroup analysis of the studies that identified the IIN showed a significant reduction of the 6th month evaluation of pain in both groups and confirmed the same trend in favor of neurectomy reported in the previous overall analysis: statistically significant reduction of pain 6 months after surgery at 3.79% (6/158) in the neurectomy group versus 14.6% (26/178) in the nerve preservation group [RR 0.28, 95% CI 0.13–0.63; Z = 3.10 (P = 0.002)]. Conclusion Ilioinguinal nerve identification in Lichtenstein inguinal hernia repair is the fundamental step to reduce or avoid postoperative pain. Prophylactic ilioinguinal nerve neurectomy seems to offer some advantages concerning pain in the first 6th month postoperative period, although it might be possible that the small number of cases contributed to the insignificancy regarding paresthesia and hypoesthesia. Nowadays, prudent surgeons should discuss with patients and their families the uncertain benefits and the potential risks of neurectomy before performing the hernioplasty.

scholarly journals Ilio inguinal neurectomy in inguinal hernia

2017 ◽  
Vol 4 (9) ◽  
pp. 2977
Author(s):  
T. Mohanapriya ◽  
T. R. Karthikeyan ◽  
K. Balaji Singh ◽  
T. Arulappan
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Controlled Trial ◽  
Chronic Groin Pain ◽  
Study Group ◽  
Ilioinguinal Nerve ◽  
Nerve Preservation ◽  
Significant Complication ◽  
Lichtenstein Hernia Repair ◽  
Surgery Department

Background: Inguinal hernia is one of the most common surgery done in any hospital. Chronic inguinal pain is one of the common problem these patients complain of. This study aims at evaluating the long-term outcomes of neuralgia and paraesthesia following routine ilioinguinal nerve division, compared to nerve preservation when performing Lichtenstein’s inguinal hernia repair.Methods: The present study is a randomized controlled trial of 60 cases of inguinal hernias admitted in General Surgery Department in our hospital. The patients were randomly chosen into Lichtenstein hernia repair with ilioinguinal neurectomy or Lichtenstein hernia repair with nerve preservation. After surgery, all patients were monitored carefully for pain and paraesthesia. Pain was assessed using visual analogue scale. Paraesthesia was assessed by the monofilament test and evaluated after comparison with the opposite side.Results: In the present study, the incidence of pain as well as the severity of pain is far higher in the nerve preservation study group as opposed to the neurectomy study group. Hypaesthesia is not a significant complication following ilioinguinal neurectomy and does not significantly add to the morbidity of the patient.Conclusions: Prophylactic neurectomy can be an appropriate solution in the prevention of chronic groin pain following Lichtenstein inguinal hernia repair and can be considered as an ideal inclusion into the standard hernia repair procedures. Hypoesthesia is not a significant complication following ilioinguinal neurectomy and does not significantly add to the morbidity of the patient.

scholarly journals A prospective study comparing prophylactic division versus preservation of the ilioinguinal nerve in open Lichtenstein inguinal hernioplasty

2021 ◽  
Vol 8 (2) ◽  
pp. 524
Author(s):  
Waleed Yusif El-Sherpiny ◽  
Tamer M. Elmahdy ◽  
Hosam Barakat Barakat
Keyword(s):  
Hernia Repair ◽  
Groin Pain ◽  
Randomized Study ◽  
Major Complication ◽  
Chronic Groin Pain ◽  
University Hospitals ◽  
Inguinal Hernioplasty ◽  
Ilioinguinal Nerve ◽  
Nerve Preservation ◽  
Lichtenstein Hernia Repair

Background: Inguinal hernia is one of the most common surgeries done all over the world. Chronic groin pain is one of the most annoying problems after mesh hernioplasty. This study aimed at evaluating the incidence of chronic groin pain and numbness occurring after prophylactic ilioinguinal neurectomy, as compared to its preservation during Lichtenstein’s inguinal hernioplasty. Methods: This prospective randomized study involved 90 patients complaining of inguinal hernias admitted to the department of general surgery, Tanta university hospitals during the study period. Our patients were divided randomly in two equal groups. (Group A) patients were subjected to Lichtenstein hernia repair with ilioinguinal neurectomy while (group B) patients were subjected to Lichtenstein hernia repair with nerve preservation. Post-operatively the incidence of groin pain and numbness were assessed in all patients. The pain was evaluated using a visual analogue scale. Whereas numbness was examined by the monofilament test and evaluated in comparison to the opposite side.Results: In the present study, the incidence of pain was higher in nerve preservation study group whereas, numbness was not a major complication after prophylactic ilioinguinal nerve division and did not add to patient morbidity.Conclusions: Prophylactic ilioinguinal nerve division could be an appropriate and beneficial solution for chronic groin pain after the Lichtenstein procedure and may be added as a surgical step during the classic procedures for hernia repair. Also, numbness was not a major complication after the prophylactic division of the ilioinguinal nerve and did not add to the patient morbidity.

scholarly journals Audit of Patient Outcomes after Lichtenstein Hernioplasty for the Repair of Adult Inguinal Hernia

2019 ◽  
Vol 16 (2) ◽  
pp. 54-58
Author(s):  
Md Ibrahim Siddique ◽  
Samia Mubin ◽  
Krisna Rani Majumder ◽  
Muhammad Ali Siddiquee
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Mesh Repair ◽  
Groin Pain ◽  
General Surgeon ◽  
Chronic Groin Pain ◽  
Tension Free ◽  
Lichtenstein Hernioplasty

Background: Inguinal hernia repair is one of the most commonly performed surgeries worldwide. While numerous surgical approaches exist to treat inguinal hernias, the Lichtenstein tension-free mesh repair remains the gold standard. This retrospective study is carried out to evaluate the short and long term outcomes of Lichtenstein hernioplasty in the hand of a general surgeon. Patients and Methods: A retrospective analysis of all adult inguinal hernia repair by Lichtenstein method between January .2003 and December 2009 was carried out. The outcome measures were early post-operative complications, incidence of chronic groin pain and recurrence rate. Results: A total of 526 procedures were carried out in 445 adult male patients during the study period. The median age of the patients was 49 years (range, 21-73 years). All patients underwent Lichtenstein hernioplasty under spinal anesthesia. Length of hospital stay was median 2.4 days (range, 1-4 days). Median time to the resumption of normal activities was 8 days (range, 5-1 0 days). Urinary retention was the most frequent early post-operative complication (5.1 6%). Rate of wound infection was acceptable (0.44%). Chronic groin pain was experienced by three patients (0.67%). There was no recurrence observed among the 291 (65.4% of the total) patients who were available after two years of the procedure. Conclusion: The Lichtenstein open tension-free mesh repair of adult inguinal hernia is a safe procedure with least post-operative morbidity and least chance for recurrence. It is a simple technique, quick and. easy to perform without compromising the patient's care and long-term outcome in the hand of an experienced general surgeon. Journal of Surgical Sciences (2012) Vol. 16 (2) : 54-58

scholarly journals Prophylactic ilio-inguinal neurectomy following Lichtenstein tension free hernioplasty for inguinal hernia: a prospective study

2019 ◽  
Vol 6 (8) ◽  
pp. 2731
Author(s):  
Preetham Raj G. ◽  
Nagaraja A. L. ◽  
Surendran V. ◽  
Abhilash Sharma ◽  
Ibrahim Shariff ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Prospective Study ◽  
Groin Pain ◽  
Chronic Groin Pain ◽  
Ilioinguinal Nerve ◽  
Tension Free ◽  
Nerve Preservation ◽  
Group A ◽  
Group B ◽  
A Prospective Study

Background: The objective of the study was to evaluate effect of prophylactic ilio-inguinal neurectomy on incidence of chronic groin pain following the Lichtenstein tension free hernioplasty for inguinal hernia.Methods: This prospective study included male cases admitted with uncomplicated inguinal hernia. Patients were categorised into two groups: Group A: Ilioinguinal nerve preserved, Group B: Ilioinguinal nerve excision. Standard tension-free Lichtenstein mesh repair was adopted. Patients were followed up for assessment of chronic groin pain, hypoesthesia, and numbness at post-operative day (POD) 3, POD14, 1 month and 3 months. Visual analog scale (VAS) was used to assess severity of pain. Sensory assessment was done using standard Semmes-Weinstein monofilament test. Student t test was used and a 2-sided p<0.05 was considered significant.Results: A total of 60 patients with uncomplicated inguinal hernia underwent Lichenstein mesh Hernioplasty (mean age of patients in nerve preservation: 35.8±11.9 years and nerve excision group: 42.7±9.6 years). Postoperative pain significantly decreased in group B at POD 3 (65.5% vs. 89.7%, p=0.01) and 3 months (0% vs. 24.1%, p=0.003) when compared to group A. Prevalence of numbness reduced significantly in group A at 3 month (44.8% vs. 86.2%, p=0.001). Although post-operative hypo aesthesia was comparable between the groups at POD 3 (84.6% vs. 78.1%), it decreased significantly in group A at 3 months (27.6 % vs. 86.2%, p<0.001) when compared to group B.Conclusions: Prophylactic excision of ilio-inguinal nerve during Lichtenstein mesh hernia repair decreases the incidence of chronic groin pain after surgery, without additional morbidities.

Outcome of tension free open mesh repair of inguinal hernia

2020 ◽  
Vol 22 (1) ◽  
pp. 21-24
Author(s):  
Mohammad Masum ◽  
Md Aminul Islam ◽  
Masflque Ahmed Bhuiyan ◽  
Kazi Mazharul Lslam ◽  
Md Selim Morshed ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Mesh Repair ◽  
Groin Hernia ◽  
Synthetic Mesh ◽  
Indirect Inguinal Hernia ◽  
Prolene Mesh ◽  
Tension Free ◽  
Open Mesh Repair

Background: In the practice of General Surgery, hernia repair is the second most common procedure after appendectomy. Several methods have been developed over the years to try to improve hernia repair. Good result can be expected using Bassini's, McVay's, Shouldice's techniques provided the exact nature of hernia is recognized and the repair is done without tension using healthy tissue. The introduction of synthetic mesh started a new era in hernia surgery. The use of synthetic mesh repair of primary and recurrent hernias has gradually gained acceptance among surgeons. Objective: To find out the outcome and complications of open inguinal hernia repair with prolene mesh. Methods: This is a prospective cross sectional study conducted at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from December, 2011 to May, 2012. One hundred patients of inguinal hernia admitted in different surgical units of BSMMU, Dhaka for elective surgery were studied. We have given 1 gm ijv Cephradine per operatively and then 500 gm cephradine ijv 6 hourly for 24 hours followed by oral form of Cephradine for next 5 days. Polypropylene mesh of 11 cm x 7 cm size was used in all cases. All the operations were done by open tension free prolene mesh repair technique. Patients were followed for one year to see the outcome. Results: Out of 100 cases of inguinal hernia, 71 patients (71%) had indirect inguinal hernia and 29 cases (29%) had direct inguinal hernia; 90 cases (90%) were primary hernia and only 10 cases (10%) were recurrent hernia; 58 cases were right sided, 34 cases (34%) were left sided and 8 cases (8%) were bilateral. Complications of mesh repair of groin hernia in this study included wound infection (5%), scrotal oedema (2%), mesh infection (0%), scrotal hematoma (2%), echymoces of peri-incisional skin (5%), early wound and groin pain (7%), chronic inguinodynia (2%), hernia recurrence (1%). Conclusion: In the present study an attempt is made to evaluate the outcome of patients undergoing inguinal hernia repair by prolene mesh. The results confirm that Lichtenstein tension free mesh repair of inguinal hernia is safe and reliable for both primary and recurrent groin hernia, with less recurrence rate. Patient's compliance was good with minimum morbidity. Journal of Surgical Sciences (2018) Vol. 22 (1): 21-24

Lichtenstein Versus Desarda’s Technique of Hernia Repair

2020 ◽  
Vol 22 (2) ◽  
pp. 99-103
Author(s):  
Md Fardhus ◽  
AMSM Sharfuzzaman ◽  
Md Nayeem Dewan ◽  
Md Abul Hossain ◽  
Ahmed Sami Al Hasan ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Mesh Repair ◽  
Operative Time ◽  
Seroma Formation ◽  
Age Group ◽  
Serous Fluid ◽  
Medical College ◽  
Randomized Control ◽  
And Gender

Aim: To compare Desarda’s versus Lichtenstein’s mesh repair in patients with unilateral, primary, reducible inguinal hernia in terms of mean operative time and seroma formation Methods: This randomized control trial conducted at Department of Surgery, Patuakhali Medical College & Hospital, Patuakhali. Eighty patients with unilateral, primary, reducible inguinal hernia were randomly distributed into two groups to undergo hernia repair i.e. Lichtenstein (L) and Desarda’s (D). Outcome was measured in terms of mean operative time and seroma formation. Seroma formation was defined as presence of enclosed cavity containing serous fluid determined by ultrasonography at 30th post-operative day. Results: Thirty three patients (41.25%) were above 50 years of age, whereas remaining 47 patients (58.75%) were below 50 years of age. Five patients (6.25%) were female and 75 patients(93.75%) were male. Seroma formation was 5% in Desarda’s group while 7.5% in Lichtenstein group (P> 0.05). Similarly difference in mean operative time was statistically non-significant. Seroma formation was common in older age group. There was no effect of smoking, obesity, operative time and gender on seroma formation. Conclusion: It is concluded that there is no difference in frequency of seroma formation and mean operative time in Desarda’s or Lichtenstein’s technique of hernia repair. Journal of Surgical Sciences (2018) Vol. 22 (2) : 99-103

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