Introduction: Chronic pain following Lichtenstein repair of inguinal hernia surgery has incidence of 6 - 29% and has emerged as a common and sometimes severe problem that can significantly affect a patient’s health-related quality of life. It occurs due to entrapment, ligation, neuroma or fibrotic reactions involving any of the nerves at inguinal region of which the ilioinguinal nerve is most commonly involved. Though the excision of ilioinguinal nerve should theoretically eliminate the possibility of inguinal neuralgia, this concept of routine ilioinguinal nerve excision in inguinal hernia repairs is not well accepted. The present study was done with the aim to compare and correlate the therapeutic effectiveness of routine ilioinguinal neurectomyin chronic inguinodynia.

Materials and Methods: A total of 50 patients were admitted or primary inguinal hernia repair (unilateral or bilateral), satisfying all the inclusion criteria in the study. All patients were treated with Lichtenstein tension-free hernioplasty with polypropelene mesh. In one group of 25 patients, i.e (Group-A) Ilioinguinal nerve was identified and excised. In another group of 25 patients i.e. (Group-B) ilioinguinal nerve preserved. Post-operative assessment for chronic groin pain and numbness was carried out at 1 month, 6 month and 1 year.  At the end of the study both the group of patients i.e. nerve excision group (group-A) and nerve preservation group (group-B) were compared forincidence of post-herniorrhaphy groin pain & post herniorrhaphy groin numbness.

Observations: This prospective study showed a satisfactory decrease in the incidence of post-operative groin pain at 1 month, 6 months and 1 year, for patients in the ilioinguinal nerve excision group versus nerve preservation group. This study also clearly demonstrated that, elective excision of ilioinguinal nerve is not accompanied by a significant increase in post-operative groin numbness.

Conclusion: The result of this prospective trial demonstrates that prophylactic excision of ilioinguinal nerve during Lichtenstein tension free hernioplasty significantly decreases the incidence of chronic groin pain and not associated with additional morbidities in terms of local cutaneous neurosensory disturbances and ilioinguinal neurectomy should be considered as a routine surgical step during open mesh hernia repairs.

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Dr Sudarshan Sethy