Inguinal Nerve Management During Lichtenstein Inguinal Hernia Repair_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Bin , CHEN Jinhui

Department of General Surgery， The Eighth Hospital of Changsha， Changsha 410100， Hunan Province， China;

Corresponding author：

Keywords：

Inguinal hernia; Herniorraphy; Postoperative pain

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Objective 　To discuss the prophylactic effect of handling inguinal nerves correctly duing Lichtenstein inguinal hernia repair on chronic pain after operation.
Methods 　158 patients with inguinal hernia who were treated in our hospital from February 2007 to March 2010 were given Lichtenstein hernia repair. The ilioinguinal nerves were carefully identified and preserved during the operation, the nerve excision had been carried on only in the cases of existing nerve injuried or interference with the position of the mesh.
Results 　The identification rate of iliohypogastric nerve, ilioinguinal nerve, and genital branch of genitofemoral nerve was 87.97%（139/158）, 82.28%（130/158）, and 34.18%（54/158）, respectively. The postoperative complication rate was 5.06%（8/158）, in which subcutaneous hydrops 5 cases, scrotal hematoma 2 cases, and wound infection 1 case, all recovered by conservative management. There was not inguinal hernia recurrence in 12 months of follow-up. In 1 month after operation, there were 63（39.87%） patients suffered from mild pain and 34（21.52%） patients suffered from moderate pain in inguinal region, there was no patient with severe pain, the mean pain score was 0.83. The incidence of chronic groin pain in 6 months was 5.06% （8/158）, in which 7（4.43%） patients suffered from mild pain, and 1（1/158） patient suffered from moderate pain. In 12 months, only 4（2.53%） patients still experience occasional pain or discomfort, the mean pain score was 0.03. Multinomial logistic regression analysis indicated that neurectomy had no influence on postoperative pain（P＞0.05）and non-identification of ilioinguinal nerve was a risk factor for early（1 month） postoperative moderate pain（OR=3.373, P=0.030）.
Conclusions 　Standard surgical procedure acted according to the Lichtenstein guidelines and handling inguinal nerves correctly can result in low incidence of chronic pain after operation, and can make the patients have a better quality of life.

Citation： LIU Bin,CHEN Jinhui,.. Inguinal Nerve Management During Lichtenstein Inguinal Hernia Repair. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2012, 19(3): 314-318. doi: Copy

1.	周建平，舒国顺. 腹股沟疝修补术后慢性疼痛 [J/OL]. 中华疝和腹壁外科杂志( 电子版)， 2009， 3(4)： 371-375．.
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4.	中华医学会外科学分会疝和腹壁外科学组. 成人腹股沟疝、股疝和腹部手术切口疝手术治疗方案(2003 年修订稿) [J]. 中华外科杂志， 2004， 42(14)： 834-835．.
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6.	Erhan Y， Erhan E， Aydede H， et al. Chronic pain after Lichtenstein and preperitoneal (posterior) hernia repair [J]. Can J Surg，2008， 51(5)： 383-387.
7.	Massaron S， Bona S， Fumagalli U， et al. Analysis of post-surgical pain after inguinal hernia repair：a prospective study of 1 440 operations [J]. Hernia， 2007， 11(6)： 517-525.
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9.	Rosen MJ， Novitsky YW， Cobb WS， et al. Combined open and laparoscopic approach to chronic pain following open inguinal hernia repair [J]. Hernia， 2006， 10(1)： 20-24.
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11.	Mui WL， Ng CS， Fung TM， et al. Prophylactic ilioinguinal neurectomy in open inguinal hernia repair： a double-blind randomized controlled trial [J]. Ann Surg， 2006， 244(1)： 27-33.
12.	Crea N， Pata G. Effects of prophylactic ilioinguinal nerve excision in mesh groin hernia repair： short- and long-term followup of a randomized clinical trial [J]. Am Surg， 010， 76(11)：1275-1281.
13.	Caliskan K， Nursal TZ， Caliskan E， et al. A method for the reduction of chronic pain after tension-free repair of inguinal hernia：iliohypogastric neurectomy and subcutaneous transposition of the spermatic cord [J]. Hernia， 2010， 14(1)： 51-55.
14.	Simons MP， Aufenacker T， Bay-Nielsen M， et al. European hernia society guidelines on the treatment of inguinal hernia in adult patients [J]. Hernia， 2009， 13(4)： 343-403.
15.	Karakayali F， Karatas M， Ozcelik U， et al. Influence of synthetic mesh on ilioinguinal nerve motor conduction and chronic groin pain after inguinal herniorrhaphy： a prospective randomized clinical study [J]. Int Surg， 2007， 92(6)： 344-350.
16.	Wijsmuller AR， Lange JF， Kleinrensink GJ， et al. Nerve-identifying inguinal hernia repair： a surgical anatomical study [J].World J Surg， 2007， 31(2)： 414-420.
17.	Reinpold WM， Nehls J， Eggert A. Nerve management and chronic pain after open inguinal hernia repair： a prospective two phase study [J]. Ann Surg， 2011， 254(1)： 163-168.
18.	Smeds S， Löfström L， Eriksson O. Influence of nerve identification and the resection of nerves ‘at risk’ on postoperative pain in open inguinal hernia repair [J]. Hernia， 2010， 14(3)： 265-270.
19.	Amid PK. Causes， prevention， and surgical treatment of postherniorrhaphy neuropathic inguinodynia： triple neurectomy with proximal end implantation [J]. Hernia， 2004， 8(4)： 343-349.
20.	Amid PK， Hiatt JR. New understanding of the causes and surgical treatment of postherniorrhaphy inguinodynia and orchalgia [J]. J Am Coll Surg， 2007， 205(2)： 381-385.
21.	Negro P， Basile F， Brescia A， et al. Open tension-free Lichtenstein repair of inguinal hernia： use of fibrin glue versus sutures for mesh fixation [J]. Hernia， 2011， 15(1)： 7-14.
22.	Khaleal F， Berney C. The role of fibrin glue in decreasing chronic pain in laparoscopic totally extraperitoneal (TEP) inguinal hernia repair： a single surgeon’s experience [J]. ANZ J Surg， 2011，81(3)： 154-158.
23.	申英末，陈杰，刘素君，等. 康派特医用胶在腹股沟疝无张力修补术中的应用 [J]. 中华疝和腹壁外科杂志：电子版，2010， 4(1)： 17-21.
24.	臧鸿声. 自体神经原位再植治疗截肢( 指) 残端神经瘤 [J].中华显微外科杂志， 1991， 14(3)： 137-138.
25.	Paajanen H. A single-surgeon randomized trial comparing three composite meshes on chronic pain after Lichtenstein hernia repair in local anesthesia [J]. Hernia， 2007， 11(4)： 335-339.

1. 周建平，舒国顺. 腹股沟疝修补术后慢性疼痛 [J/OL]. 中华疝和腹壁外科杂志( 电子版)， 2009， 3(4)： 371-375．.
2. 吴强，于游，王灿. 无张力腹股沟疝修补术后慢性疼痛原因分析及治疗 [J]. 中国普外基础与临床杂志， 2009， 16(2)：95-97.
3. Paily A， Thornton M. Chronic pain following a Lichtenstein inguinal hernia repair： a clinical and legal dilemma [J]. ANZ J Surg， 2009， 79(7-8)： 517-520.
4. 中华医学会外科学分会疝和腹壁外科学组. 成人腹股沟疝、股疝和腹部手术切口疝手术治疗方案(2003 年修订稿) [J]. 中华外科杂志， 2004， 42(14)： 834-835．.
5. Alfieri S， Rotondi F， Di Giorgio A， et al. Influence of preservation versus division of ilioinguinal， iliohypogastric， and genital nerves during open mesh herniorrhaphy： prospective multicentric study of chronic pain [J]. Ann Surg， 2006， 243(4)： 553-558.
6. Erhan Y， Erhan E， Aydede H， et al. Chronic pain after Lichtenstein and preperitoneal (posterior) hernia repair [J]. Can J Surg，2008， 51(5)： 383-387.
7. Massaron S， Bona S， Fumagalli U， et al. Analysis of post-surgical pain after inguinal hernia repair：a prospective study of 1 440 operations [J]. Hernia， 2007， 11(6)： 517-525.
8. Aasvang E， Kehlet H. Surgical management of chronic pain after inguinal hernia repair [J]. Br J Surg， 2005， 92(7)： 795-801.
9. Rosen MJ， Novitsky YW， Cobb WS， et al. Combined open and laparoscopic approach to chronic pain following open inguinal hernia repair [J]. Hernia， 2006， 10(1)： 20-24.
10. Pappalardo G， Frattaroli FM， Mongardini M， et al. Neurectomy to prevent persistent pain after inguinal herniorraphy： a prospective study using objective criteria to assess pain [J]. World J Surg， 2007， 31(5)： 1081-1086.
11. Mui WL， Ng CS， Fung TM， et al. Prophylactic ilioinguinal neurectomy in open inguinal hernia repair： a double-blind randomized controlled trial [J]. Ann Surg， 2006， 244(1)： 27-33.
12. Crea N， Pata G. Effects of prophylactic ilioinguinal nerve excision in mesh groin hernia repair： short- and long-term followup of a randomized clinical trial [J]. Am Surg， 010， 76(11)：1275-1281.
13. Caliskan K， Nursal TZ， Caliskan E， et al. A method for the reduction of chronic pain after tension-free repair of inguinal hernia：iliohypogastric neurectomy and subcutaneous transposition of the spermatic cord [J]. Hernia， 2010， 14(1)： 51-55.
14. Simons MP， Aufenacker T， Bay-Nielsen M， et al. European hernia society guidelines on the treatment of inguinal hernia in adult patients [J]. Hernia， 2009， 13(4)： 343-403.
15. Karakayali F， Karatas M， Ozcelik U， et al. Influence of synthetic mesh on ilioinguinal nerve motor conduction and chronic groin pain after inguinal herniorrhaphy： a prospective randomized clinical study [J]. Int Surg， 2007， 92(6)： 344-350.
16. Wijsmuller AR， Lange JF， Kleinrensink GJ， et al. Nerve-identifying inguinal hernia repair： a surgical anatomical study [J].World J Surg， 2007， 31(2)： 414-420.
17. Reinpold WM， Nehls J， Eggert A. Nerve management and chronic pain after open inguinal hernia repair： a prospective two phase study [J]. Ann Surg， 2011， 254(1)： 163-168.
18. Smeds S， Löfström L， Eriksson O. Influence of nerve identification and the resection of nerves ‘at risk’ on postoperative pain in open inguinal hernia repair [J]. Hernia， 2010， 14(3)： 265-270.
19. Amid PK. Causes， prevention， and surgical treatment of postherniorrhaphy neuropathic inguinodynia： triple neurectomy with proximal end implantation [J]. Hernia， 2004， 8(4)： 343-349.
20. Amid PK， Hiatt JR. New understanding of the causes and surgical treatment of postherniorrhaphy inguinodynia and orchalgia [J]. J Am Coll Surg， 2007， 205(2)： 381-385.
21. Negro P， Basile F， Brescia A， et al. Open tension-free Lichtenstein repair of inguinal hernia： use of fibrin glue versus sutures for mesh fixation [J]. Hernia， 2011， 15(1)： 7-14.
22. Khaleal F， Berney C. The role of fibrin glue in decreasing chronic pain in laparoscopic totally extraperitoneal (TEP) inguinal hernia repair： a single surgeon’s experience [J]. ANZ J Surg， 2011，81(3)： 154-158.
23. 申英末，陈杰，刘素君，等. 康派特医用胶在腹股沟疝无张力修补术中的应用 [J]. 中华疝和腹壁外科杂志：电子版，2010， 4(1)： 17-21.
24. 臧鸿声. 自体神经原位再植治疗截肢( 指) 残端神经瘤 [J].中华显微外科杂志， 1991， 14(3)： 137-138.
25. Paajanen H. A single-surgeon randomized trial comparing three composite meshes on chronic pain after Lichtenstein hernia repair in local anesthesia [J]. Hernia， 2007， 11(4)： 335-339.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Inguinal Nerve Management During Lichtenstein Inguinal Hernia Repair

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