Effects of variable courses of inguinal nerves on pain in patients undergoing Lichtenstein repair for inguinal hernia: preliminary results.

ABSTRACT

BACKGROUND: Problems due to damage to ilioinguinal and iliohypogastric nerves which have many variations following surgery for inguinal hernia cause additional work leave and delay in return to daily life. We aimed to compare outcomes of nerve identification and preservation with a careful dissection during Lichtenstein repair of inguinal hernia between normal courses of inguinal based nerves and variable courses of inguinal based nerves. METHODS: This is a prospective study and 116 adult male patients with primary inguinal hernia were operated between December 2009 and June 2010. The patients with a normal nerve trace identified on exploration were assigned into Group Normal Course and those with variable nerve course were assigned into Group Variable Course. These two groups were compared in terms of demographic features, preoperative and postoperative variables, return to work and daily routines, duration of fulfilling personal needs, visual analogue scores before and one and six months after surgery, four-point verbal-rank scale scores, numbness and patient satisfaction. RESULTS: Out of 116 patients, 70 (60.3%) had variable courses of the nerves and were assigned into the Group Variable Course and 46 (39.7%) had normal courses of the nerves and were assigned into Group Normal Course. A single stem for both nerves over spermatic cord (21.6%) and acute infero-lateral angulation of the Ilioinguinal nerve in close contact with and parallel to the Superficial Inguinal Ring fibers at exit (15.5%) were the most observed variations. Duration of surgery was significantly longer in Group Variable Course (p <0.001). Numbness was also slightly higher in this group one month after surgery. This difference nearly disappeared six months after surgery. CONCLUSION: Although careful and gentle exploration increases the duration of surgery and early neuropraxia, identification and preservation of nerves during surgery for inguinal hernia help to achieve similar outcomes in both patients with a normal course of nerves and those with a variable course of nerves.