Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

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R. Berg and M.I. Goldblatt
Western counterparts. This only serves to reinforce that analyzing this
topic is quite challenging, as its subjectivity provides such variation.
Among the stronger evidence to date in support of routine ilioinguinal
neurectomy in patients undergoing open inguinal hernia repair is that
from Mui et al. [ 3 ]. These authors also conducted a double-blind controlled
trial randomizing 100 patients to undergo either prophylactic
ilioinguinal neurectomy or nerve preservation. In follow-up, patients
were not only asked to rate their pain generally but also were asked to
rate their pain while performing various common tasks. These included
coughing 10 times, walking up three flights of stairs, and riding a bicycle
for 10 min. Groin sensation was also tested using the Semmes-
Weinstein monofilament test . Patients were followed up to 6 months
postoperatively. At 1 month, there was not a significant difference
between the groups in groin pain or sensation. However, at 6 months, the
overall incidence of chronic groin pain was significantly lower in the
routine neurectomy group (8 vs. 29 %, p = 0.008). This incidence of pain
at 6 months was also noted to be lower when climbing three flights of
stairs (2 vs. 14 %, p = 0.03) and cycling 10 min (4 vs. 20 %, p = 0.015).
There was no significant difference in pain noted between groups at rest,
during normal daily activities, or with coughing. There were also no
objective differences in groin numbness or loss of sensation. This study
is also notable for including patient overall quality of life in its analysis,
and it found no difference between groups at any time point, including
at baseline, 1 month, and 6 months [ 3 ]. This study is commendable in
that it studied pain with multiple tasks as well as included a quality of
life measure in its analysis and notable in that it demonstrated improved
pain ratings at 6 months in patients undergoing neurectomy. It is important
to note, however, that follow-up was fairly short compared to other
studies, and while routine nerve excision was noted to decrease pain
with various activities, it also showed no significant reduction in the
incidence of pain noted at rest, pain with normal activities of daily living,
or in patient-reported improved quality of life.
Despite an ever-growing set of data examining the practice of routine
ilioinguinal neurectomy in patients undergoing inguinal hernia repair,
there is lack of consensus regarding its efficacy and potential morbidity.
Again, this may be attributed in large part to the inherent subjectivity of
the endpoints in question, namely, the incidence of chronic pain and
disabling sensory deficit. While there are data that demonstrate an
increased incidence of objective sensory loss on detailed, focused physical
exam after neurectomy, there are no strong data that support the
assertion that nerve excision increases the incidence of disabling or even