George Emily, Olson Molly A, Poulose Benjamin K
Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Department of Population Health Sciences, Weill Cornell Medicine, New York, New York.
J Surg Res. 2023 Jun;286:96-103. doi: 10.1016/j.jss.2022.10.095. Epub 2023 Feb 15.
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).
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.
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).
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.
神经损伤与慢性腹股沟疼痛有关，尤其是髂腹下神经、髂腹股沟神经和生殖股神经的生殖支。我们研究了与两种常见的神经处理策略（髂腹股沟神经识别[1N]和双神经识别[2N]）相比，三种神经识别（3N）和保留是否与疝修补术后6个月疼痛减轻相关。
我们在腹部核心健康质量协作组国家数据库中识别成年腹股沟疝患者。使用EuraHS生活质量工具定义术后6个月疼痛。在调整先验确定的混杂因素时，使用比例优势模型估计神经处理6个月疼痛的优势比（OR）和预期平均差异。
分析了4451名参与者；358名（3N）、1731名（1N）和2362名（2N），大多数为60岁以上的白人男性（84%）。学术中心比髂腹股沟或双神经识别方法更常识别出所有三条神经。所有神经处理组术后6个月疼痛评分中位数均为0[四分位间距0 - 2]（3N与1N以及3N与2N相比，P = 0.51）。调整后，神经处理方法中6个月疼痛评分较高的几率没有差异的证据（3N与1N，OR：0.95；95%置信区间0.36 - 1.95，3N与2N，OR：1.00；95%置信区间0.50 - 1.85）。
尽管指南强调保留三条神经，但所评估的处理策略与术后6个月疼痛的统计学显著差异无关。这些发现表明，在开放腹股沟疝修补术后慢性腹股沟疼痛中，神经操作可能不是一个重要因素。
