Prophylactic Ilioinguinal Neurectomy: Prevention of Chronic Pain after Open Inguinal Hernioplasty

Prophylactic ilioinguinal neurectomy in inguinal hernioplasty is not recommended for routine use in open hernia repair, and the nerve is often preserved despite the risk of nerve entrapment. Chronic postoperative discomfort has been reported in 0.7%-36.7% of patients following open inguinal hernioplasty. Several mechanisms of injury to the ilioinguinal have been identified during elective inguinal hernia repair, including suture entrapment, partial division, crushing, and diathermy injury. There is theoretical advantage to this procedure since nerve excision removes postoperative discomfort brought on by entrapment, inflammation, or fibrotic reaction around the nerve.

An observational prospective study was done on 31 patients in each group following open inguinal hernia repair with and without prophylactic ilioinguinal neurectomy. Incidence of postoperative pain, postoperative numbness, postoperative complications, and duration of hospital stay were compared.

Pain, numbness, complications were recorded at 24 and 48 h after surgery, at the time of discharge, as well as at 2 weeks, 1 month, 3 months, and 6 months follow-up. The results were better among ilioinguinal neurectomy group and were found to be statistically significant.

Prophylactic ilioinguinal neurectomy significantly lessens groin discomfort up to 6 months compared to the nerve preservation group. There was a significant reduction in postoperative pain and hospital stay. The incidence of persistent groin pain following open inguinal hernia surgery is considerably reduced by prophylactic ilioinguinal neurectomy, with no additional complications. Adding this step during routine procedures will help the patient outcome significantly.