Comparison Of Postoperative Pain In Elective Division Versus Preservation Of Ilioinguinal Nerve In Lichtenstein Inguinal Hernia Repair” A One Year Single Blinded Randomized Control Trial At KLES Dr Prabhakar Kore Hospital And MRC, Belagavi

Abstract

Background and Objectives Chronic groin pain is a significant problem following open hernia repair with mesh, although the pain is often mild in nature, the quality of life studies have shown that chronic pain irrespective of severity can significantly interfere with normal daily activity. Lichtenstein hernia repair is commonly recommended in the management of inguinal hernia. Majority of chronic pain has been attributed to ilioinguinal nerve entrapment. Routine excision of the ilioinguinal nerve in an attempt to decrease the incidence of chronic groin pain caused by nerve entrapment, inflammation, fibrotic reactions around the nerve. So the present study was undertaken to evaluate post operative groin pain in the patients with ilioinguinal nerve excision (group A) vs ilioinguinal nerve preservation (group B) in Lichtenstein inguinal hernia repair. Methodology The present one year randomized controlled trial was conducted in the Department of General Surgery, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi from January 2016 to December 2016. A total of 80 patients undergoing Lichtenstein hernia repair were randomized into two groups of 40 each as group A (excision of ilioinguinal nerve) and group B (preservation of ilioinguinal nerve). Results In the present study all the patients in both the groups were males. The mean age (52.48 ± 14.31 vs 55.93 ± 14.25 years; p=0.2836) and duration of the symptoms (0.99 ± 0.90 years vs 1.12 ± 0.85 years; p=0.5334) in group A and group B was comparable. In this study comparing the VAS on all the five follow ups there was significant lower pain scores in ilioinguinal nerve excision group than ilioinguinal nerve preservation group. The results showed the incidence of postoperative groin pain with mean severity score of 3.50±1.40 vs 5.60±2.11 ; 1.38±1.56 vs 4.35 ±1.48 ; 0.43±0.55 vs 2.38±1.51;0.28±0.45 vs 1.43 ±1.45 ; and 0.20±0.41 vs 1.03±1.27at pod-1, 3,1 week, 4 weeks, and 3 months followup in group A and B respectively, were significant (p<0.05 ). The results showed the incidence of decrease in postoperative groin pain with mean severity score of 3.08±1.40 vs 3.23±1.95(pod-1 to 1week;p=0.9195) ; 3.23±1.25 vs 4.18 ±2.07(pod-1 to 4weeks;p=0.0259) ; and 3.30±1.26 vs 4.58±1.96 ( pod-1 to 3months;p=0.021) in group A and group B respectively, were significant. Showing that the elective division of ilioinguinal nerve significantly reduced the post-operative pain as compared to preservation of ilioinginal nerve in Lichtenstein hernia repair. Conclusion and interpretation Based on the findings of the present study it may be concluded that, the elective division of ilioinguinal nerve significantly reduced the post-operative pain as compared to preservation of ilioinginal nerve in Lichtenstein hernia repair. However the sample size and the follow up period in the current study is relatively short , a larger study sample and longer follow-up may be needed before any further conclusion can be made. Although the study sample and follow period is short in this present study than the previous studies, it is still wise to recommend ilioinguinal neurectomy in patients undergoing anterior inguinal hernia mesh repair. So when performing Lichtenstein inguinal hernia repair, routine ilioinguinal neurectomy is a reasonable option.