Publication

Abstract : Aim: Identification & preservation of all three inguinal nerves (Ilioinguinal nerve (IIN), Iliohypogastric nerve (IHN), Genital branch of Genitofemoral nerve (GFN)) during Lichtenstein hernia repair compared to neurectomy of all nerves in terms of complications like chronic groin pain and altered sensation. Methods: Sixty patients with primary unilateral inguinal hernia undergoing Lichtenstein's hernioplasty under SA from August 2012 to September 2014 were divided in two groups of 30 each, with an attempt made to identify all three inguinal nerves in both the groups, and nerves preserved in one (Group A) and deliberate neurectomy done in another group(Group B). Neurectomy specimen was confirmed by HPE. Pain (at rest, during normal daily activities, on walking stairs, on prolonged standing) and complaints of altered sensation at 1, 3 and 6 months after surgery was evaluated in both groups using a visual analog scale. Results were compared using chi-square test and Fischer exact test. Results: A total of 60 patients were eligible for the study during 2 years, with study group consisting from age 20 to 50 years, highest number of patients were in the age group 40-49 years (56.66 % v/s 53.33%) and right sided indirect hernias being more common in both the groups. Ilioinguinal nerve was identified in 58 cases (96.6%), Iliohypogastric all 60 cases (100%) and Genital branch of Genitofemoral nerve in 22 cases (36.6%) with 100% histological confirmation in resection group. No statistically significant difference was found among groups for complaints of pain during normal daily activities, on walking stairs and on prolonged standing. When incidence of altered sensation was compared , a high incidence was noted at first month ( 46.67% v/s 33.33%), with gradual decrease in incidence over follow up period , at 3 month (33.33 % v/s 20%) and at 6 months (20% v/s 13.30%) but the difference was not statistically significant. Conclusion: A planned resection of the inguinal nerves at the time of hernioplasty is associated with a decrease in the incidence of chronic post-operative groin pain without any significant neurosensory disturbances. Hence neurectomy can be considered as a routine surgical step during Lichtenstein hernia repair.