ROLE OF ILIOINGUINAL NURECTOMY IN ENTRAPMENT SYNROME IN INGUINAL HERNIA REPAIR IN TERTIRY CARE HOSPITL

DR.P.MAHESH KUMAR.; DR; M. SUKRIYA

Volume : IX, Issue : III, March - 2019

ROLE OF ILIOINGUINAL NURECTOMY IN ENTRAPMENT SYNROME IN INGUINAL HERNIA REPAIR IN TERTIRY CARE HOSPITL

Dr. P. Mahesh Kumar. , Dr, M. Sukriya

Abstract :

Background and Objectives: Chronic post herniorraphy groin pain is defined as pain lasting > 3 months after surgery, which is one of the most important complication occurring after inguinal hernia repair, occurs with greater frequency than previously though. 1,2 Chronic groin pain is one of the most significant complication following inguinal hernia repair, and majority of chronic pain has been attributed to ilio inguinal nerve entrapment. Routine excision of the ilio inguinal nerve is an attempt to decrease the incidence of chronic groin pain caused by nerve entrapment, inflammation, fiotic reactions around the nerve.3,4 The purpose of the current study was to evaluate the effect of routine ilioinguinal nerve excision compared to nerve preservation on chronic groin pain and other sensory symptoms when performing lichtenstein’s inguinal hernia repair.5 METHODS: A total of 100 patients admitted for inguinal hernia at Govt.sivagangai medical college hospital, sivgangai, who met with inclusion criteria who underwent open mesh repair of inguinal hernia over the study period from may 2014 to November 2016. The ilioinguinal nerve was identified and preserved in 50 patients (group A) and ilioinguinal neurectomy done in 50 patients (group–B) were evaluated for pain and other sensory symptoms at PoD–1, at one month, at second month, and at third months after surgery by using visual analogue scale. RESULTS: 100 patients are included in the study and it was divided into two groups namely one group with the preservation of ilioinguinal nerve consisting of 50 patients named as group A and another group with ilioinguinal neurectomy done consisting of 50 patients named as group B.The results showed the incidence of postoperative chronic groin pain months after surgery are 72% vs 84% (p0.384) at POD–1 ; 56% vs 14% ( p <0.05 ) at 1 month ; 44% 12% (p<0.05) at 2 months ; and 28% vs 8%) (p<0.05) at 3 months in group A and B respectively by using Chi square test. The results showed that the incidence of postoperative chronic groin pain decreases in neurectomy group compared to nerve preservation group. The results showed no significant differences in hypoesthesia in either group, it is found to be 12% vs 44% at post operaive day–1, 10% vs 36% at 1st month, 8% vs 32% at 2nd month, 8% vs 20% at 3rd month. And the P values are 0.001, 0.004, 0.005, 0.096 at post operative day–1, 1st month, 2nd month and 3rd month respectively. The incidence of post operative numbness was compared between Group A and Group B and the results of the follow up study are as follows : 36% vs 6% at day–1 (P=0.001) , 32% vs 10% at 1st month (P=0.011), 20% vs 6% at 2nd month (P=0.001), 32% vs 10% at 1st month (P=0.011), 20$ vs 6% at 2nd month (P=0.045), 24% vs 6% at 3rd month (P=0.016). The interpretation of the results are that there is statistical significant difference between Group A and Group B regarding the incidence of post operative numbness. CONCLUSION: The ilioinguinal neurectomy during Lichtenstein mesh hernia repair decreases the incidence of chronic groin pain after surgery. Furthermore the procedure is not significantly associated with additional morbidities in terms of local cutaneous neurosensory disturbances. So when performing Lichtenstein inguinal hernia repair, routine ilioinguinal neurectomy is a reasonable option.