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Influence of nerve identification and the resection of nerves at risk on postoperative pain in open inguinal hernia repair
Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
Linköping University, Department of Computer and Information Science, Statistics. Linköping University, Faculty of Arts and Sciences.
2010 (English)In: HERNIA, ISSN 1265-4906, Vol. 14, no 3, 265-270 p.Article in journal (Refereed) Published
Abstract [en]

Surgical strategy regarding nerve identification and resection in relation to chronic postoperative pain remains controversial. A central question is whether nerves in the operation field, when identified, should be preserved or resected. In the present study, the hypotheses that the identification and consequent resection of nerves at risk have no influence on postoperative pain has been tested. A single-centre study was conducted in 525 patients undergoing Lichtenstein hernioplasty. One surgeon (364 operations, Group A) consequently resected nerves at risk for being injured and nine surgeons (161 operations, Group B) adhered to the general routine of nerve preservation. All cases were ambulatory surgery on anaesthetised patients and the groups were similar with regard to age, body mass index (BMI) and preoperative pain. Self-reported pain at 3 months was recorded on a 10-box visual analogue scale (VAS). The identification and resection of nerves were continuously registered. Statistical calculations were performed with Fishers exact test and ordinal logistic regression. There was no significant difference in the number of identified nerves in the two groups of patients (iliohypogastricus, P = 0.555; ilioinguinalis, P = 0.831; genital branch, P = 0.214). However, the number of resected nerves was significantly higher in Group A for the iliohypogastric nerve, P andlt; 0.001, but not for ilioinguinalis, P = 0.064, and genital branch, P = 0.362. Non-identification of the ilioinguinal nerve correlated to the highest level of self-reported postoperative pain at 3 months. Patients in Group A, who had nerves at risk resected from the operation field, reported significantly less postoperative pain at 3 months, P = 0.007. This register study confirms the importance of nerve identification. Nerve resection strategy with the consequent removal of nerves at risk gives a significantly better outcome in Lichtenstein hernioplasty.

Place, publisher, year, edition, pages
Springer Science Business Media , 2010. Vol. 14, no 3, 265-270 p.
Keyword [en]
Open herniorraphy, Nerve identification, Inguinal nerve resection, Postoperative pain
National Category
Social Sciences
URN: urn:nbn:se:liu:diva-57173DOI: 10.1007/s10029-010-0632-9ISI: 000278153700007OAI: diva2:323541
Available from: 2010-06-11 Created: 2010-06-11 Last updated: 2010-06-11

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Smeds, StaffanLöfström, LEriksson, Olle
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Surgery Faculty of Health SciencesDepartment of Surgery in ÖstergötlandDepartment of Thoracic and Vascular SurgeryStatisticsFaculty of Arts and Sciences
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