Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark.
Langenbecks Arch Surg. 2023 Oct 24;408(1):417. doi: 10.1007/s00423-023-03154-2.
Inguinal hernia repair is one of the most common operations worldwide and despite this, the incidence of chronic pain remains high after inguinal hernia repair. The optimal nerve handling strategy is controversial and the rate at which nerves are identified remains uncertain. This study aimed to determine the identification rates of the ilioinguinal, iliohypogastric, and genitofemoral nerves as well as nerve handling strategies.
This review was registered on PROSPERO (CRD 42023416576). PubMed, Embase, and Cochrane Central were systematically searched. Studies with more than 10 patients were included if they reported an identification rate for at least one of the nerves during elective open inguinal hernia repair in adults. Studies requiring nerve identification in their study design were excluded. Bias was assessed with the JBI critical appraisal tool and Cochrane's RoB-2 tool. The overall estimate of the prevalence was analysed with prevalence meta-analyses.
A total of 23 studies were included. The meta-analyses included 18 studies, which resulted in an identification rate of 82% (95% CI: 76-87%) for the ilioinguinal nerve, 62% (95% CI: 54-71%) for the iliohypogastric nerve, and 41% (95% CI: 27-55%) for the genitofemoral nerve. Nerves were spared in 82% of all repairs.
The ilioinguinal, iliohypogastric, and genitofemoral nerves were identified in 82%, 62%, and 41% of surgeries, respectively. Most studies used a nerve-preserving strategy. The role of nerve identification in the development of chronic pain remains uncertain, as well as the optimal nerve handling strategy.
腹股沟疝修补术是全球最常见的手术之一，但尽管如此，腹股沟疝修补术后慢性疼痛的发生率仍然很高。最佳神经处理策略存在争议，识别神经的比率仍不确定。本研究旨在确定髂腹股沟、髂腹下和生殖股神经的识别率以及神经处理策略。
本综述已在 PROSPERO（CRD42023416576）上注册。系统检索了 PubMed、Embase 和 Cochrane Central。如果研究报告了在成人择期开放式腹股沟疝修补术中至少有一条神经的识别率，则纳入了超过 10 例患者的研究。排除了在研究设计中需要识别神经的研究。使用 JBI 批判性评估工具和 Cochrane 的 RoB-2 工具评估偏倚。总体患病率估计采用患病率荟萃分析进行分析。
共纳入 23 项研究。荟萃分析纳入了 18 项研究，结果显示髂腹股沟神经的识别率为 82%（95%CI：76-87%），髂腹下神经的识别率为 62%（95%CI：54-71%），生殖股神经的识别率为 41%（95%CI：27-55%）。82%的手术中保留了神经。
髂腹股沟、髂腹下和生殖股神经的识别率分别为 82%、62%和 41%。大多数研究采用了神经保护策略。神经识别在慢性疼痛发展中的作用以及最佳神经处理策略仍不确定。
