Skip to main content
SpringerLink
Log in

Neurectomy to Prevent Persistent Pain after Inguinal Herniorraphy: A Prospective Study Using Objective Criteria to Assess Pain

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Although tension-free mesh repair has markedly improved the outcome of inguinal hernia surgery, it has only minimally reduced the incidence of persistent postoperative pain. The pathogenesis of this complication and treatment remain unclear.

Study design

In order to objectively assess whether iliohypogastric neurectomy reduces the incidence and intensity of persistent postoperative pain, we prospectively studied 100 male patients with bilateral inguinal hernia who underwent tension-free surgical repair, combined with iliohypogastric neurectomy on the right side alone. Pain was evaluated postoperatively on days 1 and 7 and at 1 and 2 years by means of a visual analog scale. Patients were given a questionnaire including coded terms for describing pain. These terms were designed to compare pain on the neurectomized and non-neurectomized sides and assess altered sensation (hypoesthesia and paresthesia) on both sides.

Results

There were differences in the incidence and intensity of pain between the neurectomized and non-neurectomized sides, though these differences were not significant. Individual patient assessment showed that from postoperative day 7 onward patients had on average less pain on the neurectomized side.

Pain reduction was more prominent in patients who scored 4 or more on the visual analog scale. No significant difference was found in the incidence of sensory alterations between the two sides. Two years after inguinal hernia repair, only one of the 100 patients studied still had persistent pain (>4 on the visual analog scale); this pain was on the non-neurectomized side.

Conclusions

Our prospective data do not reach statistical significance to claim that iliohypogastric neurectomy reduces the incidence and intensity of persistent postoperative pain after tension-free inguinal hernioplasty. Studies on larger patient samples are warranted to provide definitive, statistically supported conclusions.

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

Similar content being viewed by others

References

  1. O’Riordan DC, Kingsnorth AN. Audit of patient outcomes after herniorraphy. Surg Clin North Am 1998;78:1129–1139

    Article  PubMed  Google Scholar 

  2. The EU Hernia Trialist Collaboration. Repair of groin hernia with synthetic mesh. Meta-analysis of randomized controlled trials. Ann Surg 2002;235:322–332

    Article  Google Scholar 

  3. Banna P, Negro P, Trabucchi E. L’ernia inguinale. Arch Atti Soc It Chir 2002;1:15–19

    Google Scholar 

  4. Bassini e nuovo metodo operativo per la cura dell’ernia inguinale. R. Stabilimento Prospendini, Padova, Italy, 1889 [Monografia]

  5. Condon RE. Groin pain hernia repair. Ann Surg 2001;233:8 [editorial]

    Article  CAS  PubMed  Google Scholar 

  6. Lichtenstein IL, Shulman AG, Amid PK, et al. Cause and prevention of postherniorraphy neuralgia: a protocol for treatment. Am J Surg 1988;155:786–790

    Article  CAS  PubMed  Google Scholar 

  7. Bay-Nielsen M, Perkins FM, Kehlet H. Pain and functional impairment 1 year after inguinal herniorraphy: a nationwide questionnaire study. Ann Surg 2001;233:1–7

    Article  CAS  PubMed  Google Scholar 

  8. Wantz GE. Testicular atrophy and chronic residual neuralgia as risk of inguinal hernioplasty. Surg Clin North Am 1993;73:571–581

    CAS  PubMed  Google Scholar 

  9. Pappalardo G, Guadalaxara A, Illomei G, et al. Prevention of postherniorraphy persistent pain: results of a prospective study. Int Surg 1999;84,4:350–453

    Google Scholar 

  10. Courtney CA, Duffy K, Serpell MG, et al. Outcome of patients with severe chronic pain following repair of groin hernia. Br J Surg 2003;90:367–368

    Google Scholar 

  11. Galer BS, Jensen MP. Development and preliminary validation of a pain measure specific to neuropathic pain; the Neuropathic Pain Scale. Neurology 1997;48:332–338

    CAS  PubMed  Google Scholar 

  12. SPSS Base 11.0 for Windows. User’s guide

  13. Zuliani A, Nenna E, Costanzo A. Elementi di statistica inferenziale. Edizioni Kappa. Roma

  14. Lichtenstein IL. Herniorrhaphy—a personal experience with 6321 cases. Am J Surg 1987;153:553–559

    Article  CAS  PubMed  Google Scholar 

  15. The EU Hernia Trialist Collaboration. Mesh compared with non-mesh methods of open groin hernia repair: systematic review of randomized controlled trials. Br J Surg 2000;87:854–859

    Article  Google Scholar 

  16. Condon RE, Nyhus LM. Complications of groin hernia. In Condon RE, Nyhus LM, editors, Hernia, 4th Edition, Philadelphia, J.B. Lippincott, 1995:269–282

    Google Scholar 

  17. Poobalan AS, Bruce J, Smith WC, et al. A review of chronic pain after inguinal herniorraphy. J Pain 2003;19:48–54

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General Surgery, P. Stefanini, University “La Sapienza”, Rome, Italy

    Giuseppe Pappalardo MD, Fabrizio Maria Frattaroli MD & Anna Maria Conte MD

  2. Department of Emergency Surgery and First Aid, University “La Sapienza”, Rome, Italy

    Massimo Mongardini MD, Pier Federico Salvi MD & Augusto Lombardi MD

  3. Department of Geoeconomics, Statistics, Linguistics and Historical Studies for Territorial Analysis, Rome, Italy

    Maria Felice Arezzo

  4. via Sebastiano Conca 11, 00197, Rome, Italy

    Giuseppe Pappalardo MD

Authors
  1. Giuseppe Pappalardo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fabrizio Maria Frattaroli MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Massimo Mongardini MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Pier Federico Salvi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Augusto Lombardi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Anna Maria Conte MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Maria Felice Arezzo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Giuseppe Pappalardo MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pappalardo, G., Frattaroli, F.M., Mongardini, M. et al. Neurectomy to Prevent Persistent Pain after Inguinal Herniorraphy: A Prospective Study Using Objective Criteria to Assess Pain. World J Surg 31, 1082–1087 (2007). https://doi.org/10.1007/s00268-006-7627-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-006-7627-9

Keywords

Search

Navigation