Clinical Outcomes of Ilioinguinal Nerve Preservation Versus Elective Division During Open Lichtenstein Mesh Repair of Inguinal Hernia: A Prospective Comparative Cohort Study.
DOI:
https://doi.org/10.51168/pk9pke85Keywords:
Chronic postoperative inguinal pain, ilioinguinal nerve, inguinal hernia, Lichtenstein repair, neurectomy, neuralgia, hypoesthesiaAbstract
Background:
Chronic postoperative inguinal pain is an important cause of impaired recovery after open inguinal hernia repair. Ilioinguinal nerve entrapment, traction, fibrosis, or neuroma formation can contribute to persistent neuralgia, while prophylactic nerve division raises concern regarding sensory loss.
Objectives:
To compare postoperative groin pain, pain severity, hypoesthesia, and numbness after ilioinguinal nerve preservation versus elective division during Lichtenstein mesh repair.
Methods:
This prospective comparative cohort study enrolled 100 adults with uncomplicated inguinal hernia at King George Hospital, Visakhapatnam, from January 2023 to June 2024. Patients underwent Lichtenstein polypropylene mesh repair with ilioinguinal nerve preservation or elective excision. Ninety patients completed six-month follow-up: 44 in the preservation group and 46 in the excision group. Pain was graded using a four-point verbal scale, and sensory outcomes were assessed on postoperative day 1 and at 1, 3, and 6 months.
Results:
At six months, postoperative neuralgia occurred in 22.7% of the preservation group and 2.2% of the excision group (P=0.003). A significant difference was also present at three months (45.4% vs 8.7%; P=0.001), whereas the one-month difference was not significant. Mean pain severity progressively declined in both groups and remained lower after excision. Six-month hypoesthesia was 11.4% versus 13.0% (P=0.808), and numbness was 13.6% versus 13.0% (P=0.934), with no significant between-group differences.
Conclusion:
Elective ilioinguinal nerve division during open Lichtenstein repair was associated with substantially less chronic groin pain at three and six months without a detectable increase in hypoesthesia or numbness during the observed follow-up.
Recommendations:
Careful identification of the ilioinguinal nerve remains essential. Elective division can be considered in selected patients undergoing open Lichtenstein repair, supported by preoperative counselling and longer-term outcome surveillance.
References
1. HerniaSurge Group. International guidelines for groin hernia management. Hernia. 2018;22(1):1-165. https://doi.org/10.1007/s10029-017-1668-x
2. Stabilini C, van Veenendaal N, Aasvang E, Agresta F, Aufenacker T, Berrevoet F, et al. Update of the international HerniaSurge guidelines for groin hernia management. BJS Open. 2023;7(5):zrad080. https://doi.org/10.1093/bjsopen/zrad080
3. Chu Z, Zheng B, Yan L. Incidence and predictors of chronic pain after inguinal hernia surgery: a systematic review and meta-analysis. Hernia. 2024;28(4):967-987. https://doi.org/10.1007/s10029-024-02980-7
4. Alfieri S, Amid PK, Campanelli G, Izard G, Kehlet H, Wijsmuller AR, et al. International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery. Hernia. 2011;15(3):239-249. https://doi.org/10.1007/s10029-011-0798-9
5. Nienhuijs S, Staal E, Strobbe L, Rosman C, Groenewoud H, Bleichrodt R. Chronic pain after mesh repair of inguinal hernia: a systematic review. Am J Surg. 2007;194(3):394-400. https://doi.org/10.1016/j.amjsurg.2007.02.012
6. Amid PK. Lichtenstein tension-free hernioplasty: its inception, evolution, and principles. Hernia. 2004;8(1):1-7. https://doi.org/10.1007/s10029-003-0160-y
7. Ravichandran D, Kalambe BG, Pain JA. Pilot randomized controlled study of preservation or division of ilioinguinal nerve in open mesh repair of inguinal hernia. Br J Surg. 2000;87(9):1166-1167. https://doi.org/10.1046/j.1365-2168.2000.01529.x
8. Picchio M, Palimento D, Attanasio U, Matarazzo PF, Bambini C, Caliendo A. Randomized controlled trial of preservation or elective division of ilioinguinal nerve on open inguinal hernia repair with polypropylene mesh. Arch Surg. 2004;139(7):755-758; discussion 759. https://doi.org/10.1001/archsurg.139.7.755
9. Dittrick GW, Ridl K, Kuhn JA, McCarty TM. Routine ilioinguinal nerve excision in inguinal hernia repairs. Am J Surg. 2004;188(6):736-740. https://doi.org/10.1016/j.amjsurg.2004.08.039
10. Mui WLM, Ng CSH, Fung TMK, Cheung FKY, Wong CM, Ma TH, et al. Prophylactic ilioinguinal neurectomy in open inguinal hernia repair: a double-blind randomized controlled trial. Ann Surg. 2006;244(1):27-33. https://doi.org/10.1097/01.sla.0000217691.81562.7e
11. Malekpour F, Mirhashemi SH, Hajinasrolah E, Salehi N, Khoshkar A, Kolahi AA. Ilioinguinal nerve excision in open mesh repair of inguinal hernia-results of a randomized clinical trial: simple solution for a difficult problem? Am J Surg. 2008;195(6):735-740. https://doi.org/10.1016/j.amjsurg.2007.09.037
12. Wijsmuller AR, van Veen RN, Bosch JL, Lange JFM, Kleinrensink GJ, Jeekel J, et al. Nerve management during open hernia repair. Br J Surg. 2007;94(1):17-22. https://doi.org/10.1002/bjs.5651
13. Barazanchi AWH, Fagan PVB, Smith BB, Hill AG. Routine neurectomy of inguinal nerves during open onlay mesh hernia repair: a meta-analysis of randomized trials. Ann Surg. 2016;264(1):64-72. https://doi.org/10.1097/SLA.0000000000001613
14. Cirocchi R, Sutera M, Fedeli P, Anania G, Covarelli P, Suadoni F, et al. Ilioinguinal nerve neurectomy is better than preservation in Lichtenstein hernia repair: a systematic literature review and meta-analysis. World J Surg. 2021;45(6):1750-1760. https://doi.org/10.1007/s00268-021-05968-x
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Dr. Sadiya Semaub, Dr. A. Shivakumar, Dr. ADV Lavanya
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
