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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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30. Prophylactic Neurectomy Versus Pragmatic Neurectomy<br />

403<br />

perceptible neurologic symptoms. Additionally, the data are also mixed<br />

in regard to the efficacy <strong>of</strong> routine neurectomy in decreasing chronic<br />

groin pain. That said, there are certainly no data to suggest that the incidence<br />

<strong>of</strong> chronic groin pain is increased with routine neurectomy.<br />

Further, the data do imply that there is at least equivalence in pain outcomes<br />

with neurectomy, and there is increasing evidence in welldesigned<br />

trials that the incidence <strong>of</strong> chronic pain months after inguinal<br />

hernia repair is decreased with routine neurectomy. Given this, it is these<br />

authors’ opinion that routine ilioinguinal neurectomy is a reasonable<br />

treatment option in patients undergoing open inguinal surgery as it does<br />

not increase patient morbidity and there is an increasing body <strong>of</strong> evidence<br />

that it may decrease incidence <strong>of</strong> chronic groin pain.<br />

References<br />

1. Dittrick G, Ridl K, Kuhn J, McCarty T. Routine ilioinguinal nerve excision in inguinal<br />

hernia repairs. Am J Surg. 2004;188(6):736–40.<br />

2. Malekpour F, Mirhashemia S, Hajinasrolah E, Salehi N, Khoshkar A, Kolahi<br />

A. Ilioinguinal nerve excision in open mesh repair <strong>of</strong> inguinal hernia – results <strong>of</strong> a randomized<br />

clinical trial: simple solution for a difficult problem? Am J Surg. 2008;95(6):<br />

35–40.<br />

3. Mui W, Ng C, Fung T, Cheung F, Wong C, Ma T, et al. Prophylactic ilioinguinal neurectomy<br />

in open inguinal hernia repair: a double- blind randomized controlled trial. Ann<br />

Surg. 2006;244(1):7–33.<br />

4. Abdullah T, Iddon J, Barr L, Baildam A, Bundred N. Prospective randomized controlled<br />

trial <strong>of</strong> preservation <strong>of</strong> the intercostobrachial nerve during axillary node clearance for<br />

breast cancer. Br J Surg. 1998;85(10):1443–5.<br />

5. Ravichandran D, Kalambe B, <strong>Pain</strong> J. Pilot randomized controlled study <strong>of</strong> preservation<br />

or division <strong>of</strong> ilioinguinal nerve in open mesh repair <strong>of</strong> inguinal hernia. Br J Surg.<br />

2000;87(9):1166–7.<br />

6. Tsakayannis D, Kiriakopoulos A, Linos D. Elective neurectomy during open, “tension<br />

free” inguinal hernia repair. Hernia. 2004;8(1):67–9.<br />

7. Picchio M, Palmento D, Attanasio U, Malarazzo P, Bambini C, Caliendo A. Randomized<br />

controlled trial <strong>of</strong> preservation or elective division <strong>of</strong> ilioinguinal nerve on open inguinal<br />

hernia repair with polypropylene mesh. Arch Surg. 2004;139(7):755–8.

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