A clinical study of the incidence and disability caused by mesh neuralgia after inguinal mesh hernioplasty and the effects of prophylactic ilioinguinal neurectomy and its role in preventing chronic groin pain after inguinal hernioplasty

Authors

  • Samrat Sunkar Department of Surgery, 2Department of Pharmacology, 3Department of Medicnne, 4Department of Aneaesthesia, 5Department of Sports Medicine, Government Hospital, Joshimath, Uttarakhand, India
  • Dick B. S. Brashier Department of Pharmacology, Government Hospital, Joshimath, Uttarakhand, India
  • Kiran Bhagwat Department of Medicnne, Government Hospital, Joshimath, Uttarakhand, India
  • Vipin Sharma Department of Aneaesthesia, Government Hospital, Joshimath, Uttarakhand, India
  • Piyush Angrish Department of Sports Medicine, Government Hospital, Joshimath, Uttarakhand, India

DOI:

https://doi.org/10.18203/2349-2902.isj20180835

Keywords:

Hernioplasty, Ilioinguinal, Lichtenstein’s, Neurectomy, Residual neuralgia

Abstract

Background: Residual neuralgia, called as Inguinodynia, is an important complication unique to groin hernia repair. The reported incidence ranges between 9-63%. The symptoms are potentially disabling. Symptoms are often more pronounced on axial twisting of body. Methods for prevention include identification and preservation of all nerves, Ilioinguinal Neurectomy and triple Neurectomy during surgery.

Methods: One hundred patients underwent elective unilateral Lichtenstein’s tension free hernioplasty. 50 patients were subjected to elective ilioinguinal neurectomy. The remaining underwent standard Liechtenstein’s mesh hernioplasty, without ilioinguinal neurectomy. Randomization was achieved by allocating alternate patients to each group - prophylactic neurectomy, or nerve preservation. All patients, during each review were asked to fill out a Pain Disability Questionnaire to assess sensory loss and pain disability objectively.

Results: At completion of 6 monthly follow up pain at rest (none in group ‘A’ compared with 3 in group ‘B’), after coughing 5 times (none in group ‘A’ compared with 7 in group ‘B’), after climbing 4 flights of stairs(3 in group ‘A’ compared with 16 in group ‘B’) and after cycling for 20 minutes (11 in group ‘A’ compared with 22 in group ‘B’) were all significantly lesser in the neurectomy group as compared with the non neurectomy group. More importantly, exertional chronic pain incidence at 6 months was significantly less in group ‘A’.

Conclusions: It was concluded that pain after inguinal mesh hernioplasty is a cause of morbidity, pain was complained of by a significantly larger number of non-neurectomised patients at 6 months of follow-up, prophylactic ilioinguinal neurectomy is associated with reduced exertional chronic groin pain, disability caused by pain after inguinal hernioplasty, is significantly reduced by ilioinguinal neurectomy and an extremely significant reduction in the requirement of medication is brought about by neurectomy compared with controls. 

References

Mui WL, NG CS, Fung TM, Cheung, FK, Wong CM, Ma TH. Prophylactic Ilioinguinal Neurectomy in open Inguinal hernia repair: a double- blind randomized controlled trial. Ann Surg. 2006;244:27-33.

Alfieri S, Amid PK, Campanelli G, Izard G, Kehlet H, Wijsmuller AR, Di Miceli D, Doglietto GB. International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery. 2011;15(3):239-49.

Zwaans WA, Perquin CW, Loos MJ, Roumen RM, Schletinga MR. Mesh Removal and selective Neurectomy for Persistent Groin Pain Following Litenstein’s Repair. World J Surg. 2017.

Ramshaw B. Laparoscopic ventral hernia repair - Managing and preventing complications. Int Surg 2005;90:S48-55.

Eldabe MA, Palomo LA, Reoyo PJF, Seco GJL. Prosthetic material fixation in open inguinal hernioplasty: suture vs. synthetic glue. Cir Esp. 2012 Aug-Sep;90(7):446-52.

Amid PK, Shulman AG, Lichtenstein IL. Simultaneous repair of bilateral inguinal hernias under local anesthesia. Ann Surg. 1996;223:249-52.

Gillion JF, Fagniez PL. Chronic pain and cutaneous sensory changes after inguinal hernia repair: comparison between open and laparoscopic techniques. Hernia. 1999 Jun 1;3(2):75-80.

Rutkow IM, Robbins AW. Tension-free inguinal herniorrhaphy: a preliminary report on the ‘mesh plug’ technique. Surgery. 1993;114:3-8.

Bruce J, Drury N, Poobalan AS, Jeffrey RR, Smith WC, Chambers WA. The prevalence of chronic chest and leg pain following cardiac surgery: a historical cohort study. Pain. 2003 Jul 1;104(1-2):265-73.

Jung BF, Ahrendt GM, Oaklander AL, Dworkin RH. Neuropathic pain following breast cancer surgery: proposed classification and research update. Pain. 2003 Jul 1;104(1):1-3.

Macrae WA. Chronic pain after surgery. Br J Anaesth. 2001;87:88-98.

Perkins FM, Kehlet H. Chronic pain as an outcome of surgery. A review of predictive factors. Anesthesiology. 2000;93:1123-33.

Søndenaa K, Nesvik I, Breivik K, Kørner H. Long‐term follow‐up of 1059 consecutive primary and recurrent inguinal hernias in a teaching hospital. European Journal of Surgery. 2001 Feb 1;167(2):125-9.

Poobalan AS, Bruce J, King PM, Chambers WA, Krukowski ZH, Smith WC. Chronic pain and quality of life following open inguinal hernia repair. British Journal of Surgery. 2001;88(8):1122-6.

Aasvang E and Kehlet H. Chronic postoperative pain: the case of inguinal herniorrhaphy. British Journal of Anaesthesia. 2005 95(1):69-76.

Turk DC, Okifuji A. Definitions of commonly used pain terms. Pain terms and taxonomies of pain. 4th Ed. Philadelphia. Lippincott, Williams and Wilkins; 2009:1629.

Aasvang E, Kehlet H. Chronic postoperative pain: the case of inguinal herniorrhaphy. British Journal of Anaesthesia. 2005;95(1):69-76.

Courtney CA, Duffy K, Serpell MG, O'dwyer PJ. Outcome of patients with severe chronic pain following repair of groin hernia. BJS. 2002 Oct 1;89(10):1310-4.

Hair A, Duffy K, McLean J, Taylor S, Smith H, Walker A, Macintyre IM, O'dwyer PJ. Groin hernia repair in Scotland. British journal of surgery. 2000 Dec 1;87(12):1722-6.

Leibl BJ, Däubler P, Schmedt CG, Kraft K, Bittner R. Long‐term results of a randomized clinical trial between laparoscopic hernioplasty and Shouldice repair. British Journal of surgery. 2000 Jun 1;87(6):780-3.

Tschudi J, Wagner M, Klaiber CH, Brugger JJ, Frei E, Krähenbühl L, et al. Controlled multicenter trial of laparoscopic transabdominal preperitoneal hernioplasty vs Shouldice herniorrhaphy. Surgical endoscopy. 1996 Aug 1;10(8):845-7.

Wright D, Paterson C, Scott N, Hair A, O’dwyer PJ. Five-year follow-up of patients undergoing laparoscopic or open groin hernia repair: a randomized controlled trial. Annals of surgery. 2002 Mar;235(3):333.

Miedema BW, Ibrahim SM, Davis BD, Koivunen DG. A prospective trial of primary inguinal hernia repair by surgical trainees. Hernia. 2004 Feb 1;8(1):28-32.

Amid PK, Shulman AG, Lichtenstein IL. Simultaneous repair of bilateral inguinal hernias under local anesthesia. Ann Surg. 1996;223:249-52.

Gillion JF, Faignez PL. Chronic pain and cutaneous sensory changes after inguinal hernia repair: comparison between open and laparoscopic techniques. Hernia 1999;3:75-80.

Rutkow IM, Robbins AW. Tension-free inguinal herniorrhaphy: a preliminary report on the ‘mesh plug’ technique. Surgery. 1993;114:3-8.

EU Hernia Trialists Collaboration. Repair of groin hernia with synthetic mesh: meta-analysis of randomized controlled trials. Ann Surg. 2002;235:322-32.

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. Archives of Surgery. 2004 Jul 1;139(7):755-8.

Tsakayannis DE, Kiriakopoulos AC, Linos DA. Elective neurectomy during open, ‘tension free’ inguinal hernia repair. Hernia. 2004;8:67-9.

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Published

2018-02-26

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Original Research Articles