EVALUATION OF POSTOPERATIVE PAIN IN PRESERVATION AND ELECTVE DISSECTION OF THE ILIOINGUINAL NERVE IN INGUINAL HERNIOPLASTY

Zanita Jovanovska Spasova; Biljana Todorovska Shapova; Elizabeta Obocki Lukovska; Igor Kikerkov; Kristina Pavlovska; Elizabeta Zhogovska; Maja Slaninka Miceska

Zanita Jovanovska Spasova University Clinic for Surgical Diseases "St. Naum Ohridski " Skopje, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
Biljana Todorovska Shapova University Clinic for Surgical Diseases "St. Naum Ohridski " Skopje, Faculty of Medicine , Ss. Cyril and Methodius University in Skopje, North Macedonia
Elizabeta Obocki Lukovska University Clinic for Surgical Diseases "St. Naum Ohridski " Skopje, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
Igor Kikerkov Department of Preclinical and Clinical Pharmacology and Toxicology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
Kristina Pavlovska Department of Preclinical and clinical Pharmacology and Toxicology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
Elizabeta Zhogovska University Clinic for Plastic and Reconstructive Surgery, Faculty of Medicine, ss. Cyril and Methodius University in Skopje, North Macedonia
Maja Slaninka Miceska Department of Preclinical and Clinical Pharmacology and Toxicology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia

Abstract

The use of mesh techniques in the treatment of inguinal hernias significantly reduce recurrences. However the incidence of inguinodinia still present significant complication. The study was designed as a randomized, prospective, unilaterally blind clinical study. Forty male patients were included, to whom hernioplasty by Lichtenstein method with implantation of polypropylene mesh was performed. Patients were divided into 2 groups of twenty patients each. In first one the technique of the ilioinguinal preservation was used, and in the second one dissection of the ilioinguinal nerve was performed. At appropriate time points two types of scales were used to assessed the intensity of the pain: Numeric scale of pain (NSP) and Stanford pain scale (SPS).Data from 40 patients have been analyzed, of which 20 with preservation and 20 with dissection of the ilioinguinal nerve. Inguinodynia was present in two patients, one in each group, i.e. 5%, which indicates that there was no significant difference in the occurrence of inguinodynia in the group with preservation and dissection of the ilioingvinal nerve. No single direction can yet be given as to whether it is better to preserve or dissect the inguinal nerves, and there is also division over whether, if a neurectomy should be performed, it should be limited to the IIN or a triple neurectomy should be performed.

Key words: inguinodinia, inguinal hernia, mesh techniques.

https://doi.org/10.55302/JMS2361024js

References

1. Dinesh Prasad, Yash Pate. A study of incidence of inguinodynia in inguinal hernias repair at a tertiary center. Int Surg J. 2020 Sep;7(9): 2985-990.
2. R. Cirocchi, B. M. Henry, I. Mercurio, K. A. et all., J. Randolph. Is it possible to identify the inguinal nerves during hernioplasty?. Hernia. 2019; 23(3): 569–81.
3. Atef Mohamed Abdel Latif, Ahmed Elsayed Lotfy, et all. Elective Division Versus Preservation of The Ilioinguinal Nerve to Reduce Postoperative Pain in Hernioplasty for Inguinal Hernia. Egyptian J Hospital Med 2021 Oct;85(2): 4194-203.
4. Van Hanswijck de Jonge P, Lloyd A, Horsfall L, Tan R, O'Dwyer PJ. The measurement of chronic pain and health-related quality of life following inguinal hernia repair: a review of the literature.Hernia. 2008 Dec;12(6): 561–69.
5. Staerkle RF, Vuille-Dit-Bille RN, Fink L, Soll C, Villiger P. Chronic pain and quality of life after inguinal hernia repair using the COMI-hernia score. Langenbecks Arch Surg. 2017 Sep;402(6): 935-47.
6. M. Matikainen, J. Vironen, J. Kössi, T. Hulmi, et all. Impact of Mesh and Fixation on Chronic Inguinal Pain in Lichtenstein Hernia Repair: 5-Year Outcomes from the Finn Mesh Study. World J Surg 2021 Feb;45(2): 459-64.
7. Melkemichel M, Bringman S, Nilsson H, et all. Patient-reported chronic ain after open inguinal hernia repair with lightweight or heavyweight mesh:a prospective, patient-reported outcomes study. Br J Surg. 2020 Nov;107(12): 1659-66.
8. Elhodaky Ahmed, Saber Sherif A, Mansour Osama A. Elkhadrawy. Ilioinguinal nerve preservation vs prophylactic neurectomyin Lichtenstein tension-free mesh hernioplasty of inguinal hernia, a prospective comparative study. Egyptian J Surg. 2020 Oct–Dec;39(4): 911-19.
9. Abdul Hakeem ,Venkatesh Shanmugam. Inguinodynia following Lichtenstein tension-free hernia repair: A review. World J Gastroenterol. 2011 Apr 14; 17(14): 1791–6.
10. 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. Hernia. 2011;15(1): 7–14.
11. Lange JF, Meyer VM, Voropai DA, at all. The role of surgical expertise with regard to chronic postoperative inguinal pain (CPIP) after Lichtenstein correction of inguinal hernia.”Hernia. 2016 Jun;20(3): 349-56.
12. Bischoff JM, Aasvang EK, Kehlet H, Werner MU. Does nerve identification during open inguinal herniorrhaphy reduce the risk of nerve damage and persistent pain?. Hernia. 2012 Oct;16(5): 573-7.