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Chronic postoperative inguinal pain (CPIP) is a significant problem lasting at least 2–3 months after surgery. It may affect ∼8–16% of patients with inguinal hernia and may impair their daily lives up to 6 months postoperatively It may be caused by injury to nerves or nerves that have been stuck and damaged by sutures or perforated by fixation devices. Ilioinguinal nerve (IIN) is at the most risk for entrapment during open mesh hernioplasty, as it runs in the canal immediately beneath the divided external oblique aponeurosis and can be included in sutures used for the hernia repair or to re-approximate the external oblique fascial flaps. Traditional surgical techniques dictate IIN preservation during repair owing to morbidities associated with sensory loss and neuropathic groin pain that may be caused by nerve injury Elective division of IIN to minimize groin pain after mesh hernioplasty has been suggested by some authors.

The aim of this prospective study was to assess the effect of prophylactic ilioinguinal nerve division vs nerve preservation on the incidence and severity of chronic inguinal pain as well as sensory abnormalities following Lichtenstein tensionfree mesh hernioplasty of inguinal hernia

This is a randomized controlled clinical trial that was carried out on 240 inguinal hernias in adult male patients in the Gastrointestinal and Laparoscopic Surgery Unit, General Surgery Department, Tanta University Hospitals, during the study period (24 months, from January 2017 to December 2018) .All patients underwent Lichtenstein tension-free mesh hernioplasty for inguinal hernia. IIN was excised in group A patients as far lateral to the internal ring as possible and medially to where it entered the rectus sheath. The cut ends were left free without implantation into muscle. The nerve was preserved throughout the procedure in group B

The incidence of pain during rest and after minor exercise was significantly lower in group A than in group B (P<0.05) At 3-month and 6-month follow-up, all group A patients had no pain during rest, whereas in group B, 18 (15%) patients still had mild pain and 6 (5%) patients had moderate pain at 3 months. All 24 (20%) patients in group B reported mild pain at 6-month follow-up. The difference between both groups was statistically insignificant (P>0.05) The difference between both groups regarding severity of postoperative inguinal pain after minor exercises was statistically higher in group B than in group A, especially at follow-up periods 1, 3, and 6 months (P=0.013, 0.033, and 0.018, respectively) The difference between both groups regarding incidence of postoperative sensory changes was insignificant except for the incidence of numbness on first and seventhPOD; it was lower in preservation than neurectomy group (P=0.047)

This study revealed lower incidence of postoperative chronic groin pain. Also decreased pain severity among neurectomy group patients. The procedure was not significantly associated with additional morbidities in terms of local cutaneous sensory changes as the incidence of hypoesthesia/numbness was insignificant in both groups at most follow-up periods

Charalambous MP, Charalambous CP. Incidence of chronic groin pain following open mesh inguinal hernia repair, and effect of elective division of the ilioinguinal nerve: meta? analysis of randomized controlled trials. Hernia 2018; 22:401–409