Syed Muhammad Shafqatullah, Mehmooda Wasim, Rabbia Zubair, Zahid Mehmood, Fizzah Khalid, Naveed Khan, Hassan Ahmed.
Prophylactic ilio-inguinal neurectomy in open inguinal hernia repair.
Pak J Surg Jan ;35(3):209-13.

Objective: To evaluate the effect of ilio-inguinal neurectomy on chronic inguinodynia after Lichtenstein technique of hernia repair. Study design: Randomized controlled trial Place and duration of study: Surgical ward, Jinnah Postgradute Medical Centre, Karachi from January 2018 to December 2018. Material and Methods: 60 patients of unilateral inguinal hernia were randomly allocated in two groups, group-A (patients having prophylactic ilio-inguinal neurectomy) and group-B (patients having ilioinguinal nerve preservation). The method of using visual analogue scale was explained to the patients pre-operatively with end points as `no pain` and `worst pain`. Results: The mean pain scores experienced after various activities of daily living including cycling, climbing stairs and after coughing were taken on VAS were almost the same between the 2 groups except that mean pain score was significantly reduced at rest in nerve excision group which was 0.0_0.0 (range 0) p=0.02. Mean pain score (VAS) was significant only at rest all the time(at 1st,3rd and 6th month) with high scores when nerve was preserved (group-B) as compared to when nerve was cut (group-A) Mean pain score (VAS) was significantly higher when climbing stairs at 6th month with when nerve was preserved (group-B) as compared to when nerve was cut (group-A). However the severity scores when compared between two groups on VAS (0-10) showed less severe pain scores in group-A (ilio-inguinal neurectomy) than in patients of nerve preservation. Conclusion: Prophylactic neurectomy of ilio-inguinal nerve may be considered for routine incorporation as a surgical step during open mesh hernia repair however it only reduces chronic pain on rest significantly not on exertion and activity.

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