Prophylactic Ilioinguinal Neurectomy in Adult Open Inguinal Hernia Repair to Prevent Postoperative Chronic Pain

Masato Narita, Shogo Okamoto*, Takatomo Koshiba, Kazuhiko Yamagami, Shigeru Sakano and Masayuki Yamamoto

Department of Surgery, Shinko Hospital
Department of Surgery, Kohka Public Hospital*

Background: Preventive strategies are needed for chronic groin pain after hernia repair because conservative pain treatment is often ineffective and best results usually occur in surgical intervention. To prevent chronic groin pain, we have conducted prophylactic ilioinguinal neurectomy during surgery since March 2004. We retrospectively assessed whether prophylactic ilioinguinal neurectomy reduces the incidence of chronic groin pain after inguinal hernia repair. Patients and Methods: We studied the presence of chronic groin pain 3 months after hernia repair in 142 men (148 cases) who underwent Prolene Hernia System herniorraphy under local anesthesia from January 2003 through March 2005. Patients were given self-administered questionnaires when seen at the hospital or by mail. We divided patients into group A (nerve preservation) in which 68 patients (72 cases) underwent hernia repair without ilioingunal neurectomy from January 2003 to March 2004, and group B (ilioinguinal neurectomy) in which 74 patients (76 cases) underwent hernia repair with ilioingunal neurectomy from April 2004 to March 2005. Results: The incidence of chronic groin pain 3 months after surgery was significantly lower in group B (31.6%) than group A (15.0%) (p=0.034). On the other hand, there was no significant difference between group A and B in the occurrence of postoperative neuralgia assessed by patient's complains (group A; 17.5% vs. group B; 10.0%; p=0.242). Conclusion: We consider prophylactic ilioinguinal nerve neurectomy a potentially useful surgical step in preventing chronic groin pain following hernia repair.

Key words
inguinal hernia, chronic pain, neuralgia, neurectomy, Prolene Hernia System

Reprint requests
Masato Narita Department of Surgery, Graduate School of Medicine, Kyoto University
54 Kawahara-cho, Syogoin, Sakyo-ku, Kyoto, 606-8507 JAPAN

Accepted
March 26, 2008

To read the PDF file you will need Abobe Reader installed on your computer.