Abstract
Aims
Chronic pain following inguinal hernia repair may be related to the handling of cutaneous nerves. This study aims to investigate the frequency of cutaneous nerve division in routine practice and the effect that nerve division has on long-term pain outcomes.
Methods
The outcomes of 172 patients who underwent open inguinal hernia repair over a two-year period during the course of a clinical trial were recorded prospectively for 1 year. Pain scores for patients in whom one of the nerves was divided were compared with those of patients in whom all three were preserved.
Result
All nerves were preserved in 95 cases (55.2%). The ilioinguinal, genital and iliohypogastric nerves were divided in 33 (19.2%), 12 (7.0%) and 14 (8.1%) cases, respectively. There was no significant difference in pain scores between any of the nerve division groups compared to the group in which all three were preserved. There were three (1.7%) cases of significant chronic pain, two in which no nerves were divided.
Conclusion
The division of cutaneous nerves during inguinal hernia repair has no significant effect on postoperative pain. However, there are very few adverse outcomes, and so, a pragmatic approach of dividing nerves when they would otherwise be damaged may be appropriate.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
National Institute for Clinical Excellence (NICE) (2001) Guidance on the use of laparoscopic surgery for inguinal hernia. NICE, London, UK. Available online at http://www.nice.org.uk/pdf/Laphernias_Full_guidance.pdf
Aasvang E, Kehlet H (2005) Surgical management of chronic pain after inguinal hernia repair. Br J Surg 92(7):795–801
Dittrick GW, Ridl K, Kuhn JA, McCarty TM (2004) Routine ilioinguinal nerve excision in inguinal hernia repairs. Am J Surg 188(6):736–740
Tsakayannis DE, Kiriakopoulos AC, Linos DA (2004) Elective neurectomy during open, “tension free” inguinal hernia repair. Hernia 8(1):67–69
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(9):1166–1167
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 Chicago 139(7):755–758
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bartlett, D.C., Porter, C. & Kingsnorth, A.N. A pragmatic approach to cutaneous nerve division during open inguinal hernia repair. Hernia 11, 243–246 (2007). https://doi.org/10.1007/s10029-007-0209-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10029-007-0209-4