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Nerve identification in open inguinal hernioplasty: A meta-analysis
Mithilesh Kumar Sinha1, Apurba Barman2, Prabhas Ranjan Tripathy3
1Department of General Surgery, All India Institute of Medical Sciences, Bhubaneswar, India.
Turkish Journal of Surgery
|March 6, 2023
Summary
Identifying inguinal nerves during hernioplasty is crucial to prevent pain. Pooled data show low identification rates for the iliohypogastric nerve (71%) and genital branch (53%), highlighting a need for improved surgical techniques.
Area of Science:
- Surgical anatomy
- Minimally invasive surgery
- Pain management
Background:
- Open inguinal hernioplasty involves potential injury to three key nerves: the ilioinguinal nerve (IIN), iliohypogastric nerve (IHN), and the genital branch of the genitofemoral nerve (GB).
- Failure to identify and preserve these nerves can lead to debilitating post-operative inguinodynia.
- Current literature lacks comprehensive data on the pooled prevalence of identifying all three nerves during surgical procedures.
Purpose of the Study:
- To calculate the pooled prevalence of IIN, IHN, and GB identification during open inguinal hernioplasty.
- To assess factors influencing nerve identification rates through subgroup analysis.
Main Methods:
- A systematic search of PubMed, CENTRAL, CINAHL, ClinicalTrials.gov, and Research Square was conducted.
- Eight studies reporting on the prevalence of all three nerves were included in a meta-analysis.
- The IVhet model in MetaXL software was used for forest plot generation and subgroup analysis to address heterogeneity.
Main Results:
- Pooled prevalence rates were: IIN 84% (95% CI 67-97%), IHN 71% (95% CI 51-89%), and GB 53% (95% CI 31-74%).
- Subgroup analysis indicated higher identification rates in single-center studies and those with a primary objective of nerve identification.
- Significant heterogeneity was observed across most pooled values, except for IHN identification in single-center studies.
Conclusions:
- The pooled data reveal suboptimal identification rates for the IHN and GB during open inguinal hernioplasty.
- Significant heterogeneity and wide confidence intervals limit the utility of these pooled values as quality benchmarks.
- Nerve identification appears more successful in single-center studies and those specifically designed to focus on nerve identification.
