Prophylactic ilio-inguinal neurectomy in open inguinal hernia repair: A randomized controlled study

Background: Controversies persist regarding excision of ilioinguinal nerve after inguinal hernia repair and the procedure is not widely accepted. The present study was aimed to compare outcomes and its impact on the quality of life between routine ilioinguinal nerve excision, and nerve preservation following Lichtenstein inguinal hernia repair. Materials and Methods: Eighty-six patients scheduled for Lichtenstein inguinal hernia repair were randomly divided into two equal groups of 43 patients each. Group A patients underwent prophylactic neurectomy, whereas, in Group B patients, the nerve was preserved. Follow-up was done on day one, 3 months, 6 months, and 9 months after surgery. The primary outcome measure was the incidence of chronic groin pain, whereas secondary outcome measures were an impact on the quality of life and time to return to work. Inter-group comparison of categorical and continuous variables was done using Fisher's exact test and unpaired t-test respectively. Results: The incidence of postoperative pain at 3 months was 13/43 (30.2%) and 5/43 (11.6%) in Group B and Group A, respectively (P = 0.034). The incidence of postoperative pain at 6 months was 11/43 (25.6%) and 3/43 (7.0%) in Group B and Group A, respectively (P = 0.038). The RAND 36-Item Short-Form Health Survey parameters such as mean social functioning scores at 6 months postoperatively were 88.4 and 82.9 in Group A as Group B, respectively (P = 0.037) and mean pain score was 98.7 and 95.3 in Group A as Group B, respectively (P = 0.047). The mean time to return to work was 4.5 days and 5.7 days in Group A as Group B, respectively (P = 0.002). Conclusion: A routine ilioinguinal neurectomy is a reasonable option for preventing neuralgia when performing Lichtenstein inguinal hernia repair.