title: Resection of Ileoinguinal and Ileohypogastric Nerves Combined with Gluing in Modified Lichtenstein Repair.
abstract: We conducted a cohort trial to investigate the relevance of resection of the ilioinguinal and iliohypogastric nerves in combination with mesh fixation with BioGlue™ (CryoLife® Inc., Kennsaw, Georgia) in modified Lichtenstein repair to the development of chronic pain and hernia recurrence.1 In all, 430 patients underwent Lichtenstein repair. In 247 patients the mesh was fixed by means of glue, and in 183 patients it was fixed with conventional sutures. In all cases the inguinal nerves N. ilioinguinalis and N. iliohypogastricus were located and resected after identification to prevent nerve reaction to the mesh. The pain intensity was measured with a numeric analogous scale (NAS) 24 hours after surgery. All complications were recorded with a follow-up of up to 5 years. There was a significantly lower pain intensity level in the gluing group compared with the suture group 24 hours after surgery (0.016 t test). The level was 3.8±2.4 in bilateral hernia and 3.3±2.1 in unilateral hernia in the gluing group. It was 4.7±3.3 in unilateral and 3.7±2.2 in bilateral hernia in the suture group. The cut-suture time was lower in the gluing group. There were no severe pain syndromes (NAS≥4) in the gluing group and only 1.1% in the suture group. There was a higher incidence of non-bacterial wound infections in the gluing group (3.6%) than in the suture group (1.1%). The rate of recurrence after 5 years amounted to 2.0% in the gluing group and 2.2% in the suture group. The technique of using BioGlue™ for mesh fixation combined with systematic nerve dissection reduces acute and chronic postoperative pain after modified Lichtenstein repair. Only 2 of 430 patients suffered from severe chronic pain. Combined gluing and systematic resection of the inguinal nerves is more comfortable than standard Lichtenstein repair.
authors.affiliation: Department of Colorectal and Hernia Surgery, Lukaskrankenhaus Neuss GmbH, Academic Teaching Hospital of Heinrich Heine University, Düsseldorf, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Baer
authors.affiliation: Department of Colorectal and Hernia Surgery, Lukaskrankenhaus Neuss GmbH, Academic Teaching Hospital of Heinrich Heine University, Düsseldorf, Germany.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Bohnert
authors.affiliation: Department of Colorectal and Hernia Surgery, Lukaskrankenhaus Neuss GmbH, Academic Teaching Hospital of Heinrich Heine University, Düsseldorf, Germany.
authors.forename: Peter E
authors.initials: PE
authors.lastname: Goretzki
authors.affiliation: Department of Colorectal and Hernia Surgery, Lukaskrankenhaus Neuss GmbH, Academic Teaching Hospital of Heinrich Heine University, Düsseldorf, Germany.
authors.forename: Bernhard J
authors.initials: BJ
authors.lastname: Lammers
mesh_terms: D000005:Abdomen / Q000294:innervation* / Q000601:surgery; D000368:Aged; D015331:Cohort Studies; D006552:Hernia, Inguinal / Q000453:epidemiology / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008160:Lumbosacral Plexus / Q000601:surgery*; D008875:Middle Aged; D010149:Postoperative Pain; D012189:Retrospective Studies; D013537:Sutures; D014014:Tissue Adhesives / Q000009:adverse effects / Q000627:therapeutic use*; D058106:Wound Closure Techniques
chemical_list: D014014:Tissue Adhesives