>Year 2012, Issue 1
Pulido-Cejudo A, Carrillo-Ruiz JD, Jalife-Montaño A, Zaldívar-Ramírez FR, Hurtado-López LM
Inguinodynia in patients after inguinal hernioplasty with the Lichtenstein technique with resection versus preservation of the ipsilateral ilioinguinal nerve
Cir Gen 2012; 34 (1)
PDF: 4. Kb.
Objective: To assess inguinodynia in patients after Lichtenstein-type inguinal plasty, comparing section of the ilioinguinal nerve against its preservation.
Setting: Hernia Clinic of the General Surgery Service at the General Hospital of Mexico.
Design: Controlled double-blind clinical trial.
Statistical analysis: Wilcoxon and Mann-Whitney U tests.
Material and methods: Forty patients were subjected to Lichtenstein inguinal plasty; randomly, in 18 patients the ilioinguinal nerve was sectioned and preserved in 22 patients. We evaluated pre and postoperative cutaneous sensitivity, intensity of pain was assessed through a visual analog scale, to determine whether sectioning the ileoinguinal nerve dicreases or not the intensity of pain and presentation of postoperative inguinodynia.
Results: There was a significant difference in pain reduction in favor of patients, in whom the nerve had been sectioned, starting at 24 h after surgery (p ‹ 0.001) and at 60 days after surgery (p ‹ 0.0001), without presenting inguinodynia, allodynia, nor distress due to hypoesthesia or anesthesia.
Conclusion: Section of the ilioinguinal nerve during inguinal hernia repair with the Lichtenstein technique decreases optimally the postoperative pain, without altering importantly surface sensitivity and avoids inguinodynia.
||Inguinal hernia, inguinodynia, inguinal plasty, pain.
EU Hernia Trialists Collaboration. Repair of groin hernia with synthetic mesh: meta-analysis of randomized controlled trials. Ann Surg 2002; 235: 322-332.
Aasvang E, Kehlet H. Chronic postoperative pain: the case of inguinal herniorrhaphy. Br J Anaesth 2005; 95: 69-76.
Amid PK. A 1-stage surgical treatment for postherniorrhaphy neuropathic pain: triple neurectomy and proximal end implantation without mobilization of the cord. Arch Surg 2002; 137: 100-104.
Campanelli G, Pascual MH, Hoeferlin A, Rosenberg J, Champault G, Kingsnorth A. Randomized, controlled, blinded trial of tisseel/tissucol for mesh fixation in patients undergoing Lichtenstein technique for primary inguinal hernia repair: results of the TIMELI trial. Ann Surg 2012; 255: 650-7.
Stephenson BM. Complications of open groin hernia repair. Surg Clin North Am 2003: 83: 1255-1278.
Wantz GE. Testicular atrophy and chronic residual neuralgia as risks of inguinal hernioplasty. Surg Clin North Am 1993; 73: 571-581.
Whiteside JL, Barber MD, Walters MD, Falcone T. Anatomy of ilioinguinal and iliohypogastric nerves in relation to trocar placement and low transverse incisions. Am J Obstet Gynecol 2005; 189: 1574-1578.
Gillion JF, Fagniez PL. Chronic pain and cutaneous sensory changes after inguinal hernia repair: comparison between open and laparoscopic technique. Hernia 1999; 3: 75-80.
Bay-Nielsen M, Kehlet H, Strand L, Malmstrom J, Anderson FH, Wara P, et al. Quality assessment of herniorrhaphies in Denmark: a prospective nationwide study. Lancet 2001; 358: 1124-1128.
Page B, Paterson C, Young D, O’Dwyer PJ. Pain from primary inguinal hernia and the effect on repair on pain. Br J Surg 2002; 89: 1315-1318.
Fitzgibbons RJ, Jonasson O, Gibbs J, Dunlop DD, Henderson W, Reda D, et al. The development of a clinical trial to determine if watchful waiting is an acceptable alternative to routine herniorrhaphy for patients with minimal or no hernia symptoms. J Am Coll Surg 2003; 196: 737-742.
Stultz P, Pfeiffer KM. Peripheral nerve injuries resulting from common surgical procedures in the lower portion of the abdomen. Arch Surg 1982; 117: 324-327.
Akita K, Niga S, Yamato Y, Muneta T, Sato T. Anatomic basis of chronic groin pain with special reference to sport hernia. Surg Radiol Anat 1999; 21: 1-5.
Yucel S, Baskin LS. The neuroanatomy of the human scrotum: surgical ramifications. BJU Int 2003; 91: 393-7.
Caliskan K, Nursal TZ, Caliskan E, Parlakgumus A, Yildirim S, Noyan T. A method for the reduction of chronic pain after tension-free repair of inguinal hernia: iliohypogastric neurectomy and subcutaneous transposition of the spermatic cord. Hernia 2010; 14: 51-55.
Dittrick GW, Ridl K, Kuhn JA, McCarthy TM. Routine ilioinguinal nerve excision in inguinal hernia repairs. Am J Surg 2004; 188: 736-740.
Ravichandran D, Kalambe BG, Pain JA. Pilot randomized controlled study of preservation or division of ilioinguinal nerve in open mesh repair of inguinal hernia. Br J Surg 2000; 87: 1166-1167.
Pichio M, Palimento D, Attanasio U, Mattarazo PF, Bambini C, Caliendo A. Randomized controlled trial of preservation or elective division of ilioinguinal nerve on open inguinal hernia repair with polypropylene mesh. Arch Surg 2004; 139: 755-759.
Tsakayannis DE, Kiriakopoulos AC, Linos DA. Elective neurectomy during open “tension free” inguinal hernia repair. Hernia 2004; 8: 67-9.
Flaherty SA. Pain measurement tools for clinical practice and research. AANA J 1996; 64: 133-40.
Vásquez CS, Martínez MJ, Melchor RJ, Alcántara MF, Pulido CA, Basurto KE. ¿Modifica la resección del nervio ilioinguinal el dolor postoperatorio de plastía inguinal sin tensión con material protésico? Cir Gen 2006; 28: 177-81.
>Year 2012, Issue 1