Evaluating the Impact of Ilioinguinal Neurectomy on Postoperative Outcomes in Lichtenstein Hernia Repair: A Prospective Comparative Study

Abstract

Background. Chronic postoperative inguinal pain (CPIP) remains one of the most disabling complications following Lichtenstein hernioplasty and can adversely affect functional recovery and quality of life. Ilioinguinal neurectomy has been proposed as a method to reduce CPIP, but concerns regarding long-term sensory deficits have limited universal adoption. Aim. To evaluate the effectiveness of prophylactic ilioinguinal neurectomy in reducing postoperative pain and to assess associated sensory outcomes and quality of life following open mesh repair of inguinal hernia. Materials and methods. This prospective comparative study included 60 patients undergoing Lichtenstein hernioplasty after ethical approval (IEC No. 2022/789). Patients were randomized into two cohorts — neurectomy group (n = 30) and nerve-preservation group (n = 30). Postoperative pain (at rest, walking, moderate and vigorous activity), sensory changes (hypoesthesia/hyperesthesia), and quality-of-life scores (SF-36) were assessed at 1, 3, and 6 months. Results. Pain scores were consistently lower in the neurectomy group at all follow-up points. Significant reductions were observed during moderate activity (p = 0.008), vigorous activity (p = 0.004), and walking (p = 0.001) at 1 month. At 6 months, no patient in the neurectomy group reported pain during normal or moderate activity, while residual pain persisted in the nerve-preservation group. Early postoperative hypoesthesia was more common after neurectomy (26.7 %), but progressively declined to 10 % by 6 months, indicating no persistent sensory impairment. Quality-of-life domains showed better overall outcomes in the neurectomy group, although not statistically significant. The patients who underwent neurectomy developed sensation in the affected area after 3 months, attributable to overlapping dermatomal (collateral) nerve supply. Conclusion. Prophylactic ilioinguinal neurectomy significantly reduces postoperative activity-related pain after Lichtenstein hernia repair without adversely affecting long-term sensation or quality of life. The procedure may be safely recommended as an adjunct to improve postoperative comfort and functional recovery.