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Delibrate severance of ilioinguinal nerve & use of light weight polypropylene mesh to prevent inguinodynia following tension free inguinal hernia repair: A randomized controlled trial

Author: 
Dr. Tanusree Kundu, Dr. Ajai Aggarwal, Dr. Gunjan Shoor and Dr. Debarshi Jana
Subject Area: 
Health Sciences
Abstract: 

Background: A large volume of hernia repairs are performed worldwide, of which many are affected by chronic groin pain. Since this has direct impact on most of the daily activities, it's an important aspect in the outcome of hernia surgery. We carried out this study to assess the success of delibrate severance of Ilioinguinal nerve & use of light weight mesh to prevent inguinodynia following tension free hernia repair. Methods: 93 male patients who underwent open inguinal hernioplasty were divided into 3 groups. 31 patients in group 1 underwent delebrate severance of ilioinguinal nerve with use of Light weight polypropylene mesh, 31 patients in group 2 underwent delebrate severance of ilioinguinal nerve with use of Heavy weight polypropylene mesh, and 31 patients in group 3 underwent careful preservation of ilioinguinal nerve with random use of heavy or light weight polypropylene mesh. The 3 groups were compared for incidence of chronic groin pain, NRS pain scores, loss of sensation, paraesthesias at 3 months postoperatively. Discussion and Conclusion: Intentional severance of ilioinguinal nerve during repair of inguinal hernia along with the use of lightweight mesh can effectively prevent debilitating inguinal pain at an expense of mild and not so troublesome loss of sensation at upper medial aspect of thigh and paraesthesia. The use of light weight mesh does not have any added advantage of decreased incidence of chronic post-operative pain in the background of severed Ilioinguinal nerve. Although, further well-structured trials with improved standardization of hernias may be required for supporting above.

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