ILIOINGUINAL NERVE PRESERVATION VERSUS ELECTIVE NEURECTOMY IN LICHTENSTEIN HERNIOPLASTY: A PROSPECTIVE RANDOMIZED STUDY ON POSTOPERATIVE PAIN AND SENSORY DISTURBANCES

Abstract

Background: Chronic postoperative groin pain (inguinodynia) remains a significant complication following Lichtenstein tension-free mesh hernioplasty, with ilioinguinal nerve involvement being a primary etiological factor. This study aimed to compare the effects of elective ilioinguinal neurectomy versus nerve preservation on postoperative pain and sensory disturbances. Methods: A prospective randomized study was conducted at a tertiary care center, enrolling 150 male patients with unilateral uncomplicated inguinal hernia. Patients were randomized into two groups: Group A (nerve preservation, n=75) and Group B (elective neurectomy, n=75). All patients underwent Lichtenstein tension-free mesh hernioplasty. Postoperative outcomes including pain (assessed by Numerical Rating Scale, NRS), numbness, and hypoesthesia were evaluated on postoperative day (POD) 1, POD 7, and at 1, 3, and 6 months. Results: No significant difference in pain scores was observed on POD 1 (p=0.956). However, statistically significant differences favoring the neurectomy group emerged at POD 7 (p=0.032), 1 month (p=0.00004), 3 months (p<0.00001), and 6 months (p=0.000001). At 6 months, 81.3% of neurectomy patients reported mild pain versus 46.7% in the preservation group. Numbness and hypoesthesia were significantly more common in the neurectomy group during early follow-up but resolved substantially by 6 months, with only 6.7% reporting mild residual numbness (p=0.023) and 4% reporting mild hypoesthesia (p=0.080, non-significant). Conclusion: Elective ilioinguinal neurectomy during Lichtenstein hernioplasty significantly reduces chronic postoperative pain without causing disabling long-term sensory disturbances. This approach is recommended as a safe and effective strategy to prevent chronic inguinodynia.