TY - JOUR
T1 - Ilioinguinal nerve excision in open mesh repair of inguinal hernia-results of a randomized clinical trial
T2 - simple solution for a difficult problem?
AU - Malekpour, Fatemeh
AU - Mirhashemi, Seyyed Hadi
AU - Hajinasrolah, Esmaeil
AU - Salehi, Nourollah
AU - Khoshkar, Ali
AU - Kolahi, Ali Asghar
N1 - Copyright:
Copyright 2008 Elsevier B.V., All rights reserved.
PY - 2008/6
Y1 - 2008/6
N2 - Background: Inguinodynia is the second most common complication occurring after inguinal hernia repair. This study was undertaken to evaluate the effect of ilioinguinal nerve excision, a concept previously proposed to be performed during open hernia mesh repair, on postsurgical pain and hyposthesia. Methods: A double-blind randomized clinical trial was performed on 121 patients undergoing open anterior mesh repair of inguinal hernia in 1 center from April 2005 through June 2006. The ilioinguinal nerve was excised in half of the patients and preserved in the other half. Pain and hyposthesia at POD 1, 1 and 6 months after surgery, and 1 year after surgery was evaluated in both groups using a visual analog scale. Results were compared using chi-square analysis. Results: Of the total number of 121 patients who entered the study, with an age range of 18 to 86 years (mean ± SD 45 ± 18), 115 (95%) were male. Sixty-one were in the nerve-excision group, and 60 were in the nerve-preservation group. One hundred patients were followed-up until the end of the first year. Using the visual analog scale to detect pain severity on postsurgical day 1, mean scores in the nerve-excision and nerve-preservation groups were 2.2 ± .8 (range 1 to 4) versus 2.8 ± .7 (range 2 to 4.5), respectively (P < .001). At 1 month after surgery, these scores were .7 ± .7 (range 0 to 3) versus 1.5 ± .7 (range 0 to 3.5), respectively (P < .001). Between 6 months and 1 year after surgery, median scores of zero were detected in both groups. After postsurgical day 1, the median score of hyposthesia was near zero in both groups. Thirteen patients developed chronic inguinodynia (13%), 10 of whom were in the nerve-preservation group. Chronic postsurgical inguinodynia was seen in 6% of patients in the ilioinguinal nerve-excision and 21% of the patients in the ilioinguinal nerve-preservation group (P = .033). Comments: Neurectomy decreases postsurgical pain after elective inguinal hernia repair. Although chronic inguinodynia was less frequent in our study than reported by many previous studies, it is still wise to recommend ilioinguinal neurectomy in patients undergoing anterior inguinal hernia mesh repair.
AB - Background: Inguinodynia is the second most common complication occurring after inguinal hernia repair. This study was undertaken to evaluate the effect of ilioinguinal nerve excision, a concept previously proposed to be performed during open hernia mesh repair, on postsurgical pain and hyposthesia. Methods: A double-blind randomized clinical trial was performed on 121 patients undergoing open anterior mesh repair of inguinal hernia in 1 center from April 2005 through June 2006. The ilioinguinal nerve was excised in half of the patients and preserved in the other half. Pain and hyposthesia at POD 1, 1 and 6 months after surgery, and 1 year after surgery was evaluated in both groups using a visual analog scale. Results were compared using chi-square analysis. Results: Of the total number of 121 patients who entered the study, with an age range of 18 to 86 years (mean ± SD 45 ± 18), 115 (95%) were male. Sixty-one were in the nerve-excision group, and 60 were in the nerve-preservation group. One hundred patients were followed-up until the end of the first year. Using the visual analog scale to detect pain severity on postsurgical day 1, mean scores in the nerve-excision and nerve-preservation groups were 2.2 ± .8 (range 1 to 4) versus 2.8 ± .7 (range 2 to 4.5), respectively (P < .001). At 1 month after surgery, these scores were .7 ± .7 (range 0 to 3) versus 1.5 ± .7 (range 0 to 3.5), respectively (P < .001). Between 6 months and 1 year after surgery, median scores of zero were detected in both groups. After postsurgical day 1, the median score of hyposthesia was near zero in both groups. Thirteen patients developed chronic inguinodynia (13%), 10 of whom were in the nerve-preservation group. Chronic postsurgical inguinodynia was seen in 6% of patients in the ilioinguinal nerve-excision and 21% of the patients in the ilioinguinal nerve-preservation group (P = .033). Comments: Neurectomy decreases postsurgical pain after elective inguinal hernia repair. Although chronic inguinodynia was less frequent in our study than reported by many previous studies, it is still wise to recommend ilioinguinal neurectomy in patients undergoing anterior inguinal hernia mesh repair.
KW - Herniorrhaphy
KW - Ilioinguinal
KW - Inguinal hernia
KW - Mesh repair
KW - Neurectomy
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U2 - 10.1016/j.amjsurg.2007.09.037
DO - 10.1016/j.amjsurg.2007.09.037
M3 - Article
C2 - 18440489
AN - SCOPUS:44349135575
SN - 0002-9610
VL - 195
SP - 735
EP - 740
JO - American journal of surgery
JF - American journal of surgery
IS - 6
ER -