Preservation versus division of ilioinguinal nerve on open mesh repair of inguinal hernia: a meta-analysis of randomized controlled trials.
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.
Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, No. 252 Wu-Hsing Street, Taipei, 11031, Taiwan.
Wayne
W
Hsu
Ching-Shyang
CS
Chen
Hung-Chia
HC
Lee
Hung-Hua
HH
Liang
Li-Jen
LJ
Kuo
Po-Li
PL
Wei
Ka-Wai
KW
Tam
D059350:Chronic Pain / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D015994:Incidence; D007264:Inguinal Canal / Q000294:innervation* / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic; D013526:Surgical Mesh