POSTOPERATIVE NEURALGIA

ROUTINE ILIOINGUINAL NERVE EXCISION IN INGUINAL HERNIA REPAIRS: A SAFE ADJUNCT

Abstract

Objective: To evaluate paresthesia following routine ilioinguinal nerve excision compared to nerve preservation in patients
undergoing anterior inguinal hernioraphy. Design: prospective experimental study. Place and duration of study: The study was conducted
at Madina Teaching hospital, University Medical & Dental College, Faisalabad from July 01,2005 to June 30,2007. Patients and methods:
Two hundred and eighteen patients were operated for their inguinal hernias. Ilio-inguinal nerve preservation (n=96) and nerve excision (n=122)
was performed on alternative operation days. All patients were contacted and data was collected on incidence and duration of postoperative
paresthesia. Comparison was made by x2 analysis. Results: The patients with routine neurectomy were similar to the group without neurectomy
based on mean age (68 ± 14 vs. 58 ± 18 years). The incidence of postoperative paresthesia was not significantly higher in the neurectomy
group versus the nerve preservation group at 1 month: 15% versus 4% (P = 0.078); 6 months: 11% versus 5% (P = 0.107); 1 year: 09% versus
05% (P = 0.303); (Table 2). In patients with postoperative paresthesia, mean severity scores on a visual analog scale (0-10) were lower in the
neurectomy group versus nerve preservation group at 1 month (2.6 ± 2.0 vs. 5.2 ± 0.0) and at 6 month (2.4 ± 2.0 vs. 5.2 ± 0.0) but similar in
the neurectomy and nerve preservation patients at 1 year (2.2 ± 1.8 vs. 3.8 ± 0.0) (Table 3). Conclusion: There is a trend towards increased
incidence of subjective paresthesia in patients undergoing routine neurectomy at 1 month, but there is no significant increase at any other end
point in time. When performing anterior inguinal hernia repair, routine ilioinguinal neurectomy is a reasonable option