Peroperative Nerve Preservation During Open Hernia Repair

Background: Peroperative identification and subsequent division or preservation of the inguinal nerves during open hernia repair may influence the incidence of chronic postoperative pain. Methods: A systematic literature review was performed to identify studies investigating the influence of different types of nerve management. Results: Based on three randomized studies the pooled mean percentage of patients with chronic pain after identification and division of the ilioinguinal nerve was similar to that after identification and preservation of the ilioinguinal nerve. Two cohort studies suggested that the incidence of chronic pain was significantly lower after identification of all inguinal nerves compared with no identification of any nerve. Another cohort study reported a significant difference in the incidence of chronic pain in favour of identification and facultative pragmatic division of the genital branch of the genitofemoral nerve compared with no identification at all. Conclusion: The nerves should be identified during open hernia repair. Division of and preservation of the ilioinguinal nerve show similar results. Incidence of postoperative chronic pain may be decreased by preservation of inguinal nerves in open hernia repair. 1. Assistant Professor of Surgery, Tairunnessa Memorial Medical College, Gazipur 2. Associate Professor of Surgery, Comilla Medical College, Comilla. Correspondence: Dr. SF Kabir Methods Studies on the effect of peroperative inguinal nerve identification and subsequent division or preservation were included if they contained data on pain lasting longer than 3 months after operation9. Randomized, prospective and retrospective cohort studies were included. Study quality was assessed according to a number of variables, such as the quality of methodological reporting, whether studies were randomized, non-randomized, prospective or retrospective, method of randomization and allocation concealment, blinding of outcome assessors, attempts made to minimize bias, sample sizes and ability to measure ‘true effect’. The following data were abstracted: type of study, number of patients, baseline characteristics, type of repair, peroperative nerve treatment, follow-up period, incidence of chronic pain and type of assessment. Results: Thirteen articles on the influence of inguinal nerve management were identified, of which one letter to the editor, one editorial and one comment were excluded16-18. Two studies that investigated the influence of iliohypogastric and ilioinguinal nerve Bangladesh Journal of Anatomy January 2010, Vol. 8 No. 1 pp. 39-42