title: Identification and management of the ilio-inguinal and ilio-hypogastric nerves in open inguinal hernia repair: benefits of self-gripping mesh.
abstract: OBJECTIVE
  A large randomized, multicenter European study recently reported a reduction in early pain after open inguinal surgery when self-gripping mesh was used compared with sutured Lichtenstein repair. This secondary exploratory study is focused on the influence of nerve identification and handling on post-operative pain.
  
  
  METHODS
  Post-operative VAS pain data and Surgical Pain Scores (SPS) from 507 patients included in this study were analyzed according to whether inguinal nerves were preserved or resected during surgery to investigate whether identification and peri-operative nerve handling impact post-operative pain.
  
  
  RESULTS
  Preservation of the ilio-hypogastric nerve during Lichtenstein mesh repair with suture fixation was associated with significantly more post-operative pain compared with resection at each follow-up (p ≤ 0.003). This difference was not significant with self-gripping mesh repair. The decrease from baseline in post-operative VAS and SPS scores were significantly greater after self-gripping mesh repair compared to Lichtenstein repair at 1 year, but only when the ilio-hypogastric nerve was preserved (VAS scores, p = 0.009; SPS scores, p = 0.015). No such difference was observed with the ilio-inguinal nerve. When self-gripping mesh was used, preservation of the ilio-hypogastric nerve was associated with significantly greater decreases in post-operative pain (change in VAS score from baseline) compared with Lichtenstein repair at each follow-up (p ≤ 0.018).
  
  
  CONCLUSIONS
  The ilio-hypogastric nerve is in danger of being traumatized during Lichtenstein mesh repair with suture fixation. The use of self-gripping mesh was shown to reduce the level of post-operative pain when the ilio-hypogastric nerve was preserved. Resection of the ilio-hypogastric nerve during Lichtenstein repair eliminates this difference.
authors: Medicinskt Centrum, Linköping, St. Larsgatan 42, 582 24, Linköping, Sweden. staffan.smeds@dynatab.se.
authors: S
authors: S
authors: Smeds
authors: Catharina-Ziekenhuis, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
authors: S
authors: S
authors: Nienhuijs
authors: Medicinskt Centrum, Linköping, St. Larsgatan 42, 582 24, Linköping, Sweden.
authors: E
authors: E
authors: Kullman
authors: Derriford Hospital, Derriford Road, Plymouth, Devon, PL6 8DH, UK.
authors: D L
authors: DL
authors: Sanders
authors: Klinikum Bremen Mitte, St. Jürgen Straße 1, Bremen, Germany.
authors: T
authors: T
authors: Lehnert
authors: Imperial College London, St. Mary's Hospital, Praed Street, London, W2 1NY, UK.
authors: P
authors: P
authors: Ziprin
authors: Western Infirmary, 44 Church Street, Glasgow, Scotland, UK.
authors: M
authors: M
authors: Gingell-Littlejohn
authors: Universitaire Ziekenhuizen Leuven, Herestraat 49, Louvain, Belgium.
authors: M
authors: M
authors: Miserez
authors: Derriford Hospital, Derriford Road, Plymouth, Devon, PL6 8DH, UK.
authors: A
authors: A
authors: Kingsnorth
mesh_terms: D000328:Adult; D000368:Aged; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D008160:Lumbosacral Plexus / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000209:etiology; D010149:Postoperative Pain / Q000209:etiology; D013526:Surgical Mesh; D013536:Suture Techniques / Q000009:adverse effects*
keywords: Hernia repair; Nerve preservation; Post-operative pain; Self-gripping mesh