INGUINAL HERNIOPLASTY

ELECTIVE NEURECTOMY FOR POSTOPERATIV ENEURALGIAS

Abstract

Introduction: Chronic pain following inguinal hernia repair is becoming a significant clinical problem, involving increased number
of patients and surgeons. Much controversy exists regarding treatment. Elective division of the nerves has been proposed to reduce the risk
of chronic post operative pain. O b j e c t i v e s : To evaluate the effectiveness of elective neurectomy during open hernia mesh repair, in reducing
postoperativ pain. Materials a n d m e t h o d s : Settings: All patients admitted in SUN department of surgery, Allied Hospital Faisalabad were
included in study. Study was started after the approval of synopsis on with inguinal hernia 2n d Feb, 2007 to Aug, 2007.100 patients of inguinal
hernias were divided into 2 groups, 50 in each group i.e. group A & group B. The last patient was registered in the first week of July,
convenience nonprobability sampling was used for location of patients in two groups. Results: On day one the pain was assessed in the two
groups i.e. Group A and group B (convenience non probability sampling technique used for patient grouping).It was found to be absent in 24/50
(48 %) and 18/50 (36 %), mild in 10/50 (20 %) and 12/50 (24 %), it was moderate in10/50 (20 %) and 10/50 (20 %) and was severe in 6/50
(12%) and 10/50 (20%) in the two groups respectively. One week after operation, in groups A and B, respectively, pain assessed with the use
of the 4-point verbal scale was absent in 45 patients (90%) and 37 patients (74%), mild in 3/50 (6%) and 4/50 (8%), moderate in 2/50 (4%) and
6/50 (12%), and severe in none and 3/50 (6%). Postoperative pain was not correlated with the presence of preoperative pain, and no correlation
was evidenced in the 2 subgroups. One month after operation, follow-up visits were performed in group A patients and group B patients. In
particular, pain was absent in 46/50 (92%) patients in group A and 41/50 (82%) patients in group B. It was mild in 2 (6%) and 6/50 (12 %),
moderate in 2/50 (4%) and 2/50 (4 %) none of the patients with elective neurectomy had pain at follow up of one month and 1 (2 %)one patient
without elective neurectomy had pain. The numbness was assessed by checking sense of touch around the operated area. The difference found
between the 2 groups with respect to the presence of numbness was 15/50 (30 %) and 7/50 (14%) in the two groups i.e. group A and group
B respectively at day 1 and 12/50 (24%) and 7/50 (14%) at follow up of one week and it was 5/50 (10%) and 2/50(4%) at one month in the two
groups. C o n c l u s i o n s : When performing lichtenstein inguinal hernia repair, routine ilioinguinal, iliohypogastric and genital branch of
genitofemoral nerves neurectomy is a reasonable option.