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Role of routine ilioinguinal neurectomy in prevention of chronic postoperative pain following Lichtenstein hernioplasty

Manisha Aggarwal, Ashwani Kumar, Parth Dhamija, Sukhwinder Singh.

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BACKGROUND : Lichtenstein hernioplasty is a widely performed surgery for the repair of groin hernia. Postoperative pain is a frequent and disabling complication of this surgery. The ilioinguinal nerve, due to it’s close proximity immediately beneath the divided external oblique fascia, is most frequently involved. Theoretically, ilioinguinal nerve excision looks lucrative in prevention of postoperative neuralgia due to nerve entrapment in sutures, inflammation, fibrosis or neuroma. Methods: 120 patients with confirmed diagnosis of inguinal hernia reporting to surgery OPD and undergoing surgery were randomized in two groups: Group A (60 patients ) in which prophylactic ilioinguinal neurectomy was performed and Group B (60 patients ) in which the ilioinguinal nerve was preserved. Results: At POD 1, 2nd week, one month post operatively, the pain in the neurectomy group was lesser though it was statistically significant only at rest. However, the post operative pain was significantly lesser in neurectomy group at 3 months post operatively (p=0.024 at rest, p=0.049 during coughing, p=0.036 during walking). Numbness at post operative day 1 and until one month after surgery, was significantly higher in the neurectomy group. But the degree of numbness was insignificant in the two groups thereafter. Conclusion: Ilioinguinal neurectomy results in significantly lower incidence of chronic postoperative pain. Even in early postoperative period, the pain severity in neurectomy patients is much less than that in control group. But there is a side effect of increased incidence of numbness in area of sensory innervations of the nerve in patients undergoing elective neurectomy in the initial post operative days. This numbness should not condemn the procedure as this improved with time and the incidence was almost similar in the two groups in the long run.

Key words: Lichtenstein hernioplasty, ilioinguinal neurectomy, chronic postoperative neuralgia

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