Planned ilioinguinal nerve excision for prevention of chronic pain after inguinal hernia repair: a meta-analysis

Amanda Johner, Jason Faulds, Sam M Wiseman
Surgery 2011, 150 (3): 534-41

BACKGROUND: Inguinal hernia repair is a common operative procedure, but the development of chronic postoperative pain is a dreaded potential complication. The role of neurectomy in decreasing the incidence of chronic pain after inguinal hernia repair is currently unknown. Our objective was to determine whether a planned ilioinguinal nerve excision results in a decrease in the development of chronic pain experienced after inguinal hernia repair.

METHODS: A systematic literature review was carried out to identify studies investigating the influence of ilioinguinal nerve excision on the development of chronic pain after inguinal hernia repair. A quantitative analysis of the pooled data was carried out.

RESULTS: Of 6,023 abstracts reviewed, 4 high-quality, randomized-controlled trials were identified. The pooled mean difference in degree of pain at 6 months postoperatively on a 10-point scale was -0.29 (95% confidence interval: -0.48 to -0.11), favoring neurectomy to decrease the chance of developing chronic pain. Not surprisingly, those individuals undergoing neurectomy were also more likely to develop altered sensation at the same time point (odds ratio: 3.70, 95% confidence interval: 2.61-5.25).

CONCLUSION: A planned resection of the ilioinguinal nerve at the time of inguinal hernia repair is associated with a decrease in the incidence of chronic postoperative pain. Thus, carrying out this simple maneuver at the time of operation might decrease a major source of postoperative patient morbidity.

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