Prophylactic triple neurectomy during open tension-free inguinal hernia repair: a clinical trial for the prevention of chronic postoperative pain

Postoperative chronic inguinal pain is a common postoperative complication after open inguinal hernia repair e.g. ilioinguinal nerve entrapment is a common cause of chronic pain which may adversely affect the patients' life. Triple neurectomy (ilioinguinal, iliohypogastric, and genital branch of genitofemoral) seems to be beneficial in preventing such pain, but it may carry the risk for numbness and hypoesthesia. This is a randomized clinical trial, which took place between January 2024 and January 2025, including all patients who were operated on by open inguinal hernioplasty either with triple neurectomy or with nerve preservation. A questionnaire filled by patients either written or by telephone to assess the severity of pain was obtained three months or more after surgery. Fifty one patients were included in nerve preservation group, while 59 patients were included in neurectomy group. Eleven patients in the nerve preservation group suffered from pain of variable severity. Six, four, and one patients had mild, moderate, and sever pain, respectively. In the neurectomy group only three patients had mild pain. There was a significant difference (p = 0.008) between the two groups. At time of questionnaire, the number of patients suffered from numbness in the nerve preservation group was 7 patients versus 10 patients in the neurectomy group, which was statistically non-significant, p value = 0.641. Prophylactic triple neurectomy provides the advantage of decreasing chronic postoperative pain after open inguinal hernia surgery. While our findings are promising, further studies with larger populations are needed before recommending triple neurectomy as a standard step during inguinal hernioplasty.Clinical trial registrationNCT06327763 registered on Mar 25, 2024.