Comparison of Ilioinguinal Nerve Preservation and Division during Lichtenstein's Open Mesh Hernioplasty: An Observational Study

Despite considerable advances in inguinal hernia surgery, including laparoscopic repairs, open hernioplasties are widely practised and have extensive practical applications. Of the available techniques, Lichtenstein’s tension-free open mesh hernioplasty is now the gold standard. While the steps of surgery are standardized, considerable difference of opinion exists in the handling of the ilioinguinal nerve. Some surgeons advocate for the division of the nerve, to avoid injury, whereas some preserve the nerve in order to maintain sensation in the external genitalia and medial thigh. This prospective observational study followed 65 patients with inguinal hernias admitted to the Institute of General Surgery, Madras Medical College, Chennai. Intraoperatively, they were taken up for division or nerve preservation as per the surgeon’s decision. Postoperatively, patients were assessed for loss of sensation in the area supplied by the ilioinguinal nerve as well as chronic pain while performing normal activities. In this study, it was found that patients who underwent preservation of the ilioinguinal nerve had a statistically significantly lower incidence of chronic inguinal pain and loss of sensation. Although further studies in larger populations are warranted to establish clear guidelines favouring one variant over the other, ilioinguinal nerve preservation may be considered a non-inferior alternative to division.