Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, No. 252 Wu-Hsing Street, Taipei, 11031, Taiwan.
World J Surg. 2012 Oct;36(10):2311-9. doi: 10.1007/s00268-012-1657-2.
Chronic groin pain after inguinal hernia repair, a serious problem, is caused by entrapment of the ilioinguinal nerve either by mesh or development of fibrosis. Division of the ilioinguinal nerve during hernioplasty has been found to reduce the incidence of chronic groin pain. However, the traditional approach favors preservation of the ilioinguinal nerve during open hernia repair.
We conducted a systematic review and meta-analysis of randomized controlled trials that compared the outcomes of preservation versus division of the ilioinguinal nerve during open mesh repair of inguinal hernia. The primary outcome was the incidence of groin pain; secondary outcomes were numbness and sensory loss.
We reviewed six trials with 1,286 patients. We found no difference between the groups for the incidence of groin pain or numbness at 1, 6, and 12 months after open mesh inguinal repair. The incidence of sensory loss or change was significantly higher in the division group than in the preservation group at 6 months [risk ratio (RR) 1.25; 95 % confidence interval (CI) 1.02-1.53] and at 12 months (RR 1.55; 95 % CI 1.01-2.37) postoperatively. No significant differences between the groups were noted at any other points in time.
Preservation of the ilioinguinal nerve during open mesh repair of inguinal hernia is associated with a decreased incidence of sensory loss at 6 and 12 months postoperatively compared with that of the division technique. No significant differences were found between the groups for chronic groin pain or numbness.
腹股沟疝修补术后慢性腹股沟疼痛是一个严重的问题，其由疝网片或纤维化导致的髂腹下神经嵌压引起。在疝修补术中切开髂腹下神经已被发现可降低慢性腹股沟疼痛的发生率。然而，传统方法在开放疝修补术中倾向于保留髂腹下神经。
我们对比较开放疝网片修补术中保留与切开髂腹下神经治疗腹股沟疝的结局的随机对照试验进行了系统回顾和荟萃分析。主要结局是腹股沟疼痛的发生率；次要结局是麻木和感觉丧失。
我们复习了 6 项涉及 1286 例患者的试验。我们发现，在开放疝网片修补术后 1、6 和 12 个月时，两组在腹股沟疼痛或麻木的发生率方面无差异。切开组在术后 6 个月（风险比 [RR] 1.25；95%置信区间 [CI] 1.02-1.53）和 12 个月（RR 1.55；95%CI 1.01-2.37）时感觉丧失或改变的发生率明显高于保留组。在其他任何时间点，两组之间均无显著差异。
与切开技术相比，在开放疝网片修补术中保留髂腹下神经与术后 6 和 12 个月时感觉丧失发生率降低相关，但两组间慢性腹股沟疼痛或麻木无显著差异。
