Prophylactic Neurectomy Versus Pragmatic Neurectomy

Abstract

Chronic inguinal neuralgia is a common and potentially morbid condition following open inguinal hernia repair. This commonly results from ilioinguinal nerve entrapment, inflammation, neuroma, or fibrosis. As such, routine excision of the inguinal nerve has been proposed as a solution to this potentially disabling problem. Examining this question is challenging, in large part owing to the significant subjectivity and variability that is inherent to a patient rating his or her severity of pain and loss of sensation. That said, the issue of chronic groin pain after inguinal surgery is by its very nature a subjective complaint, and as such, subjective data are necessary and valuable in its study. When comparing routine ilioinguinal neurectomy to nerve preservation, data demonstrate that while routine excision may increase the incidence of postoperative sensory loss on detailed physical exam, it does not increase the incidence of subjectively disabling or even perceptible sensory loss on patient survey. Further, there is no evidence to suggest that nerve excision increases the incidence of chronic groin pain, and there is an increasing body of evidence to suggest that routine neurectomy may decrease chronic postoperative inguinal neuralgia. As such, routine ilioinguinal neurectomy is a reasonable treatment option in patients undergoing inguinal hernia repair.