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Preservation Versus Division of Ilioinguinal Nerve on Open Mesh Repair of Inguinal Hernia: A Meta-analysis of Randomized Controlled Trials

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Abstract

Background

Chronic groin pain after inguinal hernia repair, a serious problem, is caused by entrapment of the ilioinguinal nerve either by mesh or development of fibrosis. Division of the ilioinguinal nerve during hernioplasty has been found to reduce the incidence of chronic groin pain. However, the traditional approach favors preservation of the ilioinguinal nerve during open hernia repair.

Methods

We conducted a systematic review and meta-analysis of randomized controlled trials that compared the outcomes of preservation versus division of the ilioinguinal nerve during open mesh repair of inguinal hernia. The primary outcome was the incidence of groin pain; secondary outcomes were numbness and sensory loss.

Results

We reviewed six trials with 1,286 patients. We found no difference between the groups for the incidence of groin pain or numbness at 1, 6, and 12 months after open mesh inguinal repair. The incidence of sensory loss or change was significantly higher in the division group than in the preservation group at 6 months [risk ratio (RR) 1.25; 95 % confidence interval (CI) 1.02–1.53] and at 12 months (RR 1.55; 95 % CI 1.01–2.37) postoperatively. No significant differences between the groups were noted at any other points in time.

Conclusions

Preservation of the ilioinguinal nerve during open mesh repair of inguinal hernia is associated with a decreased incidence of sensory loss at 6 and 12 months postoperatively compared with that of the division technique. No significant differences were found between the groups for chronic groin pain or numbness.

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Conflict of Interest

The authors (Wayne Hsu, Ching-Shyang Chen, Hung-Chia Lee, Hung-Hua Liang, Li-Jen Kuo, Po-Li Wei, and Ka-Wai Tam) have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, No. 252 Wu-Hsing Street, Taipei, 11031, Taiwan

    Wayne Hsu, Ching-Shyang Chen, Hung-Chia Lee, Hung-Hua Liang, Li-Jen Kuo, Po-Li Wei & Ka-Wai Tam

  2. Evidence-Based Medicine Center, Taipei Medical University Hospital, Taipei, Taiwan

    Ka-Wai Tam

  3. Center for Evidence-Based Medicine, Taipei Medical University, Taipei, Taiwan

    Ka-Wai Tam

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  1. Wayne Hsu
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  2. Ching-Shyang Chen
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  3. Hung-Chia Lee
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  6. Po-Li Wei
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  7. Ka-Wai Tam
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Correspondence to Ka-Wai Tam.

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Hsu, W., Chen, CS., Lee, HC. et al. Preservation Versus Division of Ilioinguinal Nerve on Open Mesh Repair of Inguinal Hernia: A Meta-analysis of Randomized Controlled Trials. World J Surg 36, 2311–2319 (2012). https://doi.org/10.1007/s00268-012-1657-2

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  • DOI: https://doi.org/10.1007/s00268-012-1657-2

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