Skip to main content
SpringerLink
Log in

Incidence of chronic groin pain following open mesh inguinal hernia repair, and effect of elective division of the ilioinguinal nerve: meta-analysis of randomized controlled trials

  • Review
  • Published:
Hernia Aims and scope Submit manuscript

Abstract

Purpose

Chronic post-operative groin pain is a substantial complication following open mesh inguinal hernia repair. The exact cause of this pain is still unclear, but entrapment or trauma of the ilioinguinal nerve may have a role to play. Elective division of this nerve during hernia repair has been proposed in an attempt to reduce the incidence of chronic groin pain.

Methods

We performed a meta-analysis of nine randomized controlled trials comparing preservation versus elective division of the ilioinguinal nerve during this operation.

Results

A substantial proportion of patients having open mesh inguinal hernia repair experience chronic groin pain when the ilioinguinal nerve is preserved (estimated rate of 9.4% at 6 months and 4.8% at 1 year). Elective division of the nerve resulted in a significant reduction of groin pain at 6-months post-surgery (RR 0.47, p = 0.02), including moderate/severe pain (RR 0.57, p = 0.01). However, division of the nerve also resulted in an increase of subjective groin numbness at this time point (RR 1.55, p = 0.06). At 12-month post-surgery, the beneficial effect of nerve division on chronic pain was reduced, with no significant difference in the rates of overall groin pain (RR 0.69, p = 0.38), or of moderate-to-severe groin pain (RR 0.99, p = 0.98) between the two groups. The prevalence of groin numbness was also similar between the two groups at 12-month post-surgery (RR 0.79, p = 0.48).

Conclusions

Routine elective division of the ilioinguinal nerve during open mesh inguinal hernia repair does not significantly reduce chronic groin pain beyond 6 months, and may result in increased rates of groin numbness, especially in the first 6-months post-surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Malekpour F, Mirhashemi SH, Hajinasrolah E, Salehi N, Khoshkar A, Kolahi AS (2008) Ilioinguinal nerve excision in open mesh repair of inguinal hernia—results of a randomized clinical trial: simple solution for a difficult problem? Am J Surg 195:735–740. https://doi.org/10.1016/j.amjsurg.2007.09.037

    Article  PubMed  Google Scholar 

  2. Poobalan AS, Bruce J, Smith WC, King PM, Krukowski ZH, Chambers WA (2003) A review of chronic pain after inguinal herniorrhaphy. Clin J Pain 19:48–54

    Article  PubMed  Google Scholar 

  3. Cunningham J, Temple WJ, Mitchell P, Nixon JA, Preshaw RM, Hagen NA (1996) Cooperative hernia study. Pain in the postrepair patient. Ann Surg 224:598–602

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  4. Kehlet H, Jensen TS, Woolf CJ (2006) Peristent postsurgical pain: risk factors and prevention. Lancet 367:1618–1625

    Article  PubMed  Google Scholar 

  5. Ndiaye A, Diop M, Ndoye JM, Konaté I, Ndiaye AI, Mané L, Nazarian S, Dia A (2007) Anatomical basis of neuropathies and damage of the ilioinguinal nerve during repairs of groin hernias (about 100 dissections). Surg Radiol Anat 29:675–681

    Article  PubMed  CAS  Google Scholar 

  6. Dittrick GW, Ridl K, Kuhn JA, McCarty TM (2004) Routine ilioinguinal nerve excision in inguinal hernia repairs. Am J Surg 188:736–740

    Article  PubMed  Google Scholar 

  7. Madura JA, Madura JA 2nd, Copper CM, Worth RM (2005) Inguinal neurectomy for inguinal nerve entrapment: an experience with 100 patients. Am J Surg 189:283–287

    Article  PubMed  Google Scholar 

  8. Wijsmuller AR, van Veen RN, Bosch JL, Lange JFM, Kleinrensink GJ, Jeekel J, Lange JF (2007) Nerve management during open hernia repair. Br J Surg 94:17–22

    Article  PubMed  CAS  Google Scholar 

  9. Padulo J, Olivia F, Frizziero A, Maffulli N (2013) Basic principles and recommendations in clinical and field science. MLTJ 4:250–252

    Google Scholar 

  10. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12

    Article  PubMed  CAS  Google Scholar 

  11. Kjaergard LL, Villumsen J, Gluud C (2001) Reported methodologic quality and discrepancies between large and small randomized trials in meta-analyses. Ann Intern Med 135:982–989

    Article  PubMed  CAS  Google Scholar 

  12. Moher D, Pham B, Jones A, Cook DJ, Jadad AR, Moher M et al (1998) Does quality of reports of randomized trials affect estimates of intervention efficacy reported in meta-analyses? Lancet 352:609–613

    Article  PubMed  CAS  Google Scholar 

  13. Ravichandran D, Kalambe BG, Pain JA (2000) Pilot randomized controlled study of preservation or division of ilioinguinal nerve in open mesh repair of inguinal hernia. Br J Surg 87:1166–1167

    Article  PubMed  CAS  Google Scholar 

  14. Picchio M, Palimento D, Attanasio U, Matarazzo PF, Bambini C, Caliendo A (2004) Randomized controlled trial of preservation or elective division of ilioinguinal nerve on open inguinal hernia repair with polypropylene mesh. Arch Surg 139:755–758

    Article  PubMed  Google Scholar 

  15. Mui WL, Ng CS, Fung TM, Cheung FK, Wong CM, Ma TH et al (2006) Prophylactic ilioinguinal neurectomy in open inguinal hernia repair: a double-blind randomized controlled trial. Ann Surg 244:27–33

    Article  PubMed  Google Scholar 

  16. Karakayali F, Oksuz E, Turk E, Pekmez M, Karabulut Z, Yilmaz T, Moray G, Haberal M (2010) Effectiveness of multiple neurectomies to prevent chronic groin pain after tension-free hernia repair. Int Surg 95:40–48

    PubMed  Google Scholar 

  17. Pulido-Cejudo A, Carrillo-Ruiz JD, Jalife-Montano A, Zaldivar-Ramirez FR, Hurtado-Lopez LM (2012) Inguinodynia in patients after inguinal hernioplasty with the Lichtenstein technique with resection of the ipsilateral ilioinguinal nerve. Circ Gen 34(1):18–24

    Google Scholar 

  18. Bansal A, Rabha S, Griwan M, Karthikeyan Y (2013) Comparative evaluation of preservation versus elective division of the ilioinguinal nerve in open mesh repair of inguinal hernias. Int J Surg 30(1):1–6

    Google Scholar 

  19. Belim OB, Shah NJ, Patil MV (2014) Comparative study of preservation versus elective division of ileo inguinal nerve in open repair of inguinal hernia. IJCMAAS 2(3):14–21

    Google Scholar 

  20. Kudva A, Lakshminarayana B, Addala PK, Seetharama P (2016) A randomized control study on neurosensory outcomes of ilioinguinal neurectomy in Lichtenstein’s hernia repair. Arch Clin Exp Surg 5:94–99

    Article  Google Scholar 

  21. Kehlet H (2008) Chronic pain after groin hernia repair. Br J Surg 95:135–136

    Article  PubMed  CAS  Google Scholar 

  22. Tsakayannis DE, Kiriakopoulos AC, Linos DA (2004) Elective neurectomy during open, “tension free” inguinal hernia repair. Hernia 8:67–69

    Article  PubMed  CAS  Google Scholar 

  23. Bartlett DC, Porter C, Kingsnorth AN (2007) A pragmatic approach to cutaneous nerve division during open inguinal hernia repair. Hernia 11:243–246

    Article  PubMed  CAS  Google Scholar 

  24. Crea N, Pata G (2010) Effects of prophylactic ilioinguinal nerve excision in mesh groin hernia repair: short- and long-term follow up of a randomized clinical trial. Am Surg 76(11):1275–1281

    PubMed  Google Scholar 

  25. Khoshmohabat H, Panahi F, Alvandi AA, Mehrvarz S, Mohebi HA, Koushki ES (2012) Effect of ilioinguinal neurectomy on chronic pain following herniorrhaphy. Trauma Monit 17(3):323–328. https://doi.org/10.5812/traumamon.6581

    Article  Google Scholar 

  26. Jatoi AH, Younus SM, Ghayassuddin M, Mirani AJ, Ghayas N, Qazi A, Suchdev S, Bakshi S (2014) Comparison after preservation and elective division of ilioinguinal nerve in inguinal hernioplasty. Prof M J 21(3):559–565

    Google Scholar 

  27. Joshi A (2015) Prophylactic ilioinguinal neurectomy: can it prevent chronic groin pain after Lichtenstein inguinal hernia repair? J Kathmandu Med Coll 4(2):39–44

    Article  Google Scholar 

  28. Fon LJ, Spence RA (2000) Sportsman’s hernia. Br J Surg 87(5):545–552

    Article  PubMed  CAS  Google Scholar 

  29. Tsirline VB, Colavita PD, Belyansky I, Zemlyak AY, Lincourt AE, Heniford BT (2013) Preoperative pain is the strongest predictor of postoperative pain and diminished quality of life after ventral hernia repair. Am Surg 79(8):829–836

    PubMed  Google Scholar 

  30. Bischoff JM, Aasvang EK, Kehlet H, Werner MU (2012) Does nerve identification during open inguinal herniorrhaphy reduce the risk of nerve damage and persistent pain? Hernia 16(5):573–577

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

We would like to thank Dr. M. Picchio, Dr. F. Malekpour, and Dr. A. Pulido-Cejudo for kindly providing us with the requested information from their studies.

Author information

Authors and Affiliations

  1. Department of Surgery, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK

    M. P. Charalambous

  2. Department of Orthopaedics, Blackpool Victoria Hospital, Blackpool, UK

    C. P. Charalambous

  3. School of Medicine, University of Central Lancashire, Preston, UK

    C. P. Charalambous

Authors
  1. M. P. Charalambous
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. P. Charalambous
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. P. Charalambous.

Ethics declarations

Conflict of interest

MPC declares no conflict of interest. CPC declares no conflict of interest.

Ethical approval

Ethical approval was not required for the study, as it did not include the handling of any personal or confidential data. The study was conducted and met the ethical standards as per the recommendations outlined by Padulo et al. [9].

Human and animal rights

No animals were involved in this study.

Informed consent

No informed consent was required for this study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Charalambous, M.P., Charalambous, C.P. Incidence of chronic groin pain following open mesh inguinal hernia repair, and effect of elective division of the ilioinguinal nerve: meta-analysis of randomized controlled trials. Hernia 22, 401–409 (2018). https://doi.org/10.1007/s10029-018-1753-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10029-018-1753-9

Keywords

Search

Navigation