Feasibility study of three-nerve-recognizing Lichtenstein procedure for inguinal hernia
J F M Lange1, A R Wijsmuller, D van Geldere
1Department of Surgery, Isala Klinieken, Zwolle, The Netherlands. j.lange@erasmusmc.nl
The British Journal of Surgery
|September 30, 2009
Summary
Identifying all three inguinal nerves during Lichtenstein hernia repair is feasible and quick with proper anatomical knowledge. This nerve-recognizing approach helps prevent iatrogenic nerve damage and chronic pain.
Area of Science:
- Surgical Techniques
- Anatomy
- Pain Management
Background:
- Inguinal nerve identification in open inguinal hernia repair is linked to reduced chronic postoperative pain.
- Most Dutch surgeons do not identify all three inguinal nerves during this procedure.
- This study evaluates a nerve-recognizing Lichtenstein hernia repair's feasibility and time requirements.
Purpose of the Study:
- To assess the feasibility of a nerve-recognizing Lichtenstein hernia repair.
- To measure the additional surgical time required for nerve identification.
- To evaluate the potential for preventing iatrogenic nerve injury.
Main Methods:
- Forty patients with primary inguinal hernias underwent nerve-recognizing Lichtenstein repair.
- Four experienced hernia surgeons participated across four Dutch teaching hospitals.
- Additional time for nerve identification, iatrogenic injuries, and anatomical variations were recorded.
Main Results:
- Iliohypogastric and ilioinguinal nerves were identified within 1 minute.
- The genital branch of the genitofemoral nerve identification took up to 2 minutes.
- Twenty-five percent of ilioinguinal nerves were not identified; five patients had iatrogenic nerve damage.
Conclusions:
- Nerve-recognizing Lichtenstein hernia repair is feasible and not time-consuming with adequate anatomical knowledge.
- Standard inguinal nerve anatomy knowledge is sufficient due to low variation incidence.
- This technique allows prevention/recognition of nerve damage and deliberate neurectomy.
