• Ilioinguinal Nerve Neurectomy is better than Preservation in Lichtenstein Hernia

  Posted by Good intentions on June 28, 2021 at 1:11 pm

  People should feel free to interpret the results of these papers in a different way than I do, if they want to. I won’t be offended. My interpretation is biased. Apologies for filling up the forum with these publications, but they show which way the industry is going.

  Another very extensive and intensive effort to find a way to make “mesh” repairs better. Focused on the chronic pain problem, exploring if neurectomies help. The results are inconclusive for long-term welfare, but they recommend it to reduce “6 month pain”. Overall though, as always, “further research must be conducted”.
  I forgot to note how the title of the paper makes a very blunt and broad statement supporting neurectomy for Lichtenstein repairs, even though the analysis does not support that broad statement. Why would they do that? Another cause to “blame” for chronic pain, maybe.

  These types of papers are very interesting in that, as properly written research papers do, they lay out the reason for the work, in this case the facts of the chronic pain problem, showing how bad it is, even for the Lichtenstein repair method. But, as other recent papers do, there is no mention of pure tissue repairs. The Herniasurge Guidelines are the very first reference, #1.

  There seem to be more of these efforts cropping up, but none of them seem to support the continued use of mesh for hernia repair, as far as leading to a pain-free life for essentially all of the patients. Each paper is, ironically, a confirmation of the mesh-caused chronic pain problem. It must be disappointing for the authors but at least they went ahead with the publication.

  The ~15% number shows up again, after one year. It’s almost spooky. 25% at six months, depending on neurectomy or not.

  When reading a paper heavy with statistical interpretation be aware that “significant” can mean a small difference, not large like the word often means in common usage. If the analysis supports it, 10% can be “significantly” higher than 9%.

  https://link.springer.com/article/10.1007/s00268-021-05968-x

  Excerpts:

  “A statistically significant percentage of patients with prosthetic inguinal hernia repair had reduced groin pain at 6 months after surgery at 8.94% (38/425) in the neurectomy group versus 25.11% (113/450) in the nerve preservation group [relative risk (RR) 0.39, 95% confidence interval (CI) 0.28–0.54; Z?=?5.60 (P?<?0.00001)]. Neurectomy did not significantly increase the groin paresthesia 6 months after surgery at 8.5% (30/353) in the neurectomy group versus 4.5% (17/373) in the nerve preservation group [RR 1.62, 95% CI 0.94–2.80; Z?=?1.74 (P?=?0.08)]. At 12 months after surgery, there is no advantage of neurectomy over chronic groin pain; no significant differences were found in the 12-month postoperative groin pain rate at 9% (9/100) in the neurectomy group versus 17.85% (20/112) in the inguinal nerve preservation group…”

  “Regardless of surgical choices, the nerve identification is recommended to reduce 6th month postoperative pain: in effect in both groups with nerve identification a significant reduction of the pain and a trend in favor of neurectomy group was reported.”

  • This discussion was modified 2 years, 9 months ago by  Good intentions.

  Good intentions replied 2 years, 9 months ago 1 Member · 0 Replies
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