title: Effects of prophylactic ilioinguinal nerve excision in mesh groin hernia repair: short- and long-term follow-up of a randomized clinical trial.
abstract: We conducted a randomized clinical trial on the impact of prophylactic ilioinguinal nerve excision (INE) on neuralgia, hypoesthesia, and analgesia requirement after open herniorrhaphy as well as on sustainability of a selective approach. Ninety-seven consecutive patients undergoing a Lichtenstein procedure were treated with INE (n = 45) or preservation (NP) (n = 52). Impact of patients' age, gender, type of anesthesia, and hernia on outcomes was also evaluated by logistic regression analysis (LRA). Patients receiving INE reported less pain on postoperative days (POD) 1 and 7 and at 1 month and required less analgesia on POD 1. Overall younger patients (40 years old or younger) had more postoperative discomfort at LRA. Pain intensity was similar at 6 and 12 months after INE or NP: moderate to severe pain in 4.4 versus 11.5 per cent (P = 0.279) and 4.4 versus 9.6 per cent (P = 0.445), respectively. Hypoesthesia was more frequent after INE on POD 1 and 7:68.9 and 53.3 per cent versus 13.5 and 9.6 per cent, respectively (P < 0.0001), but no longer at 1 month: 11.1 versus 3.8 per cent (P = 0.244) as well as at 6 and 12 months (0% in both study groups). No further correlation was found by LRA. INE prevents inguinodynia up to 1 month follow-up regardless of patient variables. Moreover, the increase of hypoesthesia proved to be a short-term complication.
authors.affiliation: Department of Medical & Surgical Sciences, 1st Division of General Surgery, University of Brescia, Brescia, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Crea
authors.forename: Giacomo
authors.initials: G
authors.lastname: Pata
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D005500:Follow-Up Studies; D006119:Groin / Q000601:surgery; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007264:Inguinal Canal / Q000294:innervation*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D013526:Surgical Mesh; D016896:Treatment Outcome