Planned iliohypogastric neurectomy for prevention of chronic pain after inguinal hernia repair.

Abstract

Purpose: The present study aimed to investigate the effect of planned ilohypogastric neurectomy (IHPN) in preventing chronic postoperative inguinal pain (CPIP) after anterior herniorrhaphy (AH).

Materials and methods: This prospective, randomized study was conducted between 2016 and 2023. Emergency and incarcerated hernia cases, bilateral inguinal hernias, cases with complications such as postoperative hematoma infection, cases in which the neuroanatomy of the inguinal region was unintentionally damaged, femoral hernias, and paraplegic patients with loss of sensation who underwent anterior inguinal herniorrhaphy with prolene mesh were excluded, and the remaining 1375 patients were included in this study. The patients were randomized into preoperative control and study groups. After further excluding 247 patients (18%) in whom the IHN could not be identified during the operation, 82% of the 1375 patients (n = 1128) were included in this study. In the control group, the RCA segment of the IHN that would remain under the mesh was preserved (control group = G1 = 534). The second group in which this segment of the RCA was excised comprised the study group (G2 = 594). Two groups were prospectively followed and pain scores (PS) were recorded regularly with a 4-point scale. The average follow-up period was 15 months (range 11-19 months) in G1 and 14 months (range 10-18 months) in G2.

Results: The number of patients with CPIP was 68 in G1 and 19 in G2, this difference was found to be statistically significant (p: < 0.001). There were 19 patients in G1 and 41 patients in G2 with loss of sensation in the operation area, and a significant difference was detected in this respect (p = 0.012).

Conclusion: The rate of developing CPIP was significantly lower in patients who underwent IHPN during anterior herniorrhaphy than in those who did not undergo IHPN. The subjective nature of the pain sensation complicates measuring and scoring this sensation and methodologically limits the study.