Abstract
Introduction
Nerve damage has been implicated in chronic groin pain, particularly iliohypogastric,
ilioinguinal, and genital branches of genitofemoral nerves. We investigated whether
three nerve identification (3N) and preservation is associated with decreased pain
6 mo after hernia repair compared to two common strategies of nerve management: ilioinguinal
nerve identification (1N) and two nerve identification (2N).
Methods
We identified adult inguinal hernia patients within the Abdominal Core Health Quality
Collaborative national database. Six-month postoperative pain was defined using the
EuraHS Quality of Life tool. A proportional odds model was used to estimate odds ratios
(ORs) and expected mean differences in 6-month pain for nerve management while adjusting
for confounders identified a priori.
Results
Four thousand four hundred fifty one participants were analyzed; 358 (3N), 1731 (1N),
and 2362 (2N) consisting mostly of White males (84%) over the age of 60 y old. Academic
centers identified all three nerves more often than ilioinguinal or two nerve identification
methods. Median 6-month postoperative pain scores were 0 [interquartile range 0-2]
for all nerve management groups (P = 0.51 3N versus 1N and 3N versus 2N). There was no evidence of a difference in the odds of higher 6-month pain score
in nerve management methods after adjustment (3N versus 1N OR: 0.95; 95% confidence interval 0.36-1.95, 3N versus 2N OR: 1.00; 95% confidence interval 0.50-1.85).
Conclusions
Although guidelines emphasize three nerve preservation, the management strategies
evaluated were not associated with statistically significant differences in pain 6 mo
after operation. These findings suggest that nerve manipulation may not contribute
as a significant role in chronic groin pain after open inguinal hernia repair.
Keywords
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Article info
Publication history
Published online: February 15, 2023
Accepted:
October 16,
2022
Received in revised form:
September 11,
2022
Received:
February 9,
2022
Identification
Copyright
© 2022 Published by Elsevier Inc.
