Charitakis Emmanouil, Haj-Ali Eyman, Al Hasani-Pfister Farah, Saad Baraa, Ortlieb Niklas, Haberstroh Amanda, Ponholzer Florian, Taha-Mehlitz Stephanie, Schupp Lisa-Marie, Bauer Robert Christian, Lamm Sebastian, Frey Daniel M, Rosenberg Robert, Taha Anas
Faculty of Medicine, University of Basel, Basel, Switzerland.
Emergency Department, Al-Habib Medical Group, Riyadh, Saudi Arabia.
Hernia. 2025 Aug 12;29(1):249. doi: 10.1007/s10029-025-03438-0.
This meta-analysis aims to analyze the outcomes of neurectomy for treating chronic post herniorrhaphy pain (CPIP), with a focus on the efficacy of various surgical approaches (open, laparoscopic transabdominal, endoscopic retroperitoneal and combined approach), and types of neurectomy-single, double and triple.
The research was registered with PROSPERO (CRD42023475401). A search in MEDLINE, Embase, Scopus, and Cochrane Central databases was conducted from the inception to November 2023. All participants aged 18 years and older who underwent neurectomy for treating CPIP were included. PRISMA guidelines were followed, selecting only randomized controlled trials, cohort studies and case series. A random-effects model was used for single-arm analyses, while the inverse variance and Mantel-Haenszel methods were employed for two-arm analyses.
The analysis includes fifteen studies involving 701 patients. Following neurectomy, 90% of the patients experienced an improvement in pain overall. Only 9.4% of the patients had postoperative complications. Among the surgical types, triple neurectomy demonstrated the highest overall pain improvement rate at 98.2%. Double neurectomy showed the highest rate of complete pain relief at 80.1%, but it also had a higher complication rate of 15.3%. In terms of surgical approach, the endoscopic retroperitoneal method not only had the highest overall improvement rate of 95.5% compared to other approaches but also the highest complication rate of 28.7%.
Neurectomy was shown to be an effective treatment for neuropathic CPIP across various surgical techniques. Randomized controlled trials would be of vital importance to facilitate the evolution of surgical strategy and patient outcomes.
本荟萃分析旨在分析神经切除术治疗慢性疝修补术后疼痛（CPIP）的效果，重点关注各种手术方式（开放手术、腹腔镜经腹手术、内镜腹膜后手术和联合手术）以及神经切除术类型（单神经切除术、双神经切除术和三神经切除术）的疗效。
该研究已在PROSPERO（CRD42023475401）注册。从数据库创建至2023年11月，在MEDLINE、Embase、Scopus和Cochrane Central数据库中进行了检索。纳入所有接受神经切除术治疗CPIP的18岁及以上参与者。遵循PRISMA指南，仅选择随机对照试验、队列研究和病例系列。单臂分析采用随机效应模型，双臂分析采用逆方差法和Mantel-Haenszel法。
分析纳入15项研究，共701例患者。神经切除术后，90%的患者总体疼痛得到改善。仅9.4%的患者出现术后并发症。在手术类型中，三神经切除术的总体疼痛改善率最高，为98.2%。双神经切除术的完全疼痛缓解率最高，为80.1%，但并发症发生率也较高，为15.3%。在手术方式方面，内镜腹膜后手术不仅总体改善率最高，为95.5%，高于其他手术方式，而且并发症发生率也最高，为28.7%。
神经切除术被证明是治疗各种手术技术引起的神经性CPIP的有效方法。随机对照试验对于促进手术策略的发展和改善患者预后至关重要。
