Postoperative pain in Lichtenstein with Iliohypogastric neurectomy compared to standard Lichtenstein repair in patients with Inguinal hernia at Mulago Hospital.

Abstract

Background: Groin hernias comprise a great percentage of the surgical volume and account for high morbidity rates worldwide. Inguinal hernia repair is one of the most common surgical procedures. In recent years great importance has been put on short-term comfort of the patient as measured by postoperative pain. Iliohypogastric neurectomy has been shown to significantly reduce post operative pain. There was need to evaluate the effectiveness of Iliohypogastric neurectomy in patients undergoing Lichtenstein repair as a Day Surgery procedure at Mulago Hospital. Study Objectives: The study was to compare the short-term and medium-term Post Operative Pain Scores of the Lichtenstein repair with and without Iliohypogastric neurectomy. Methodology: It was a Double Blinded Randomized Clinical Trial. A total of 96 patients with Primary Inguinal Hernias were recruited in the Surgical Outpatient Department of Mulago Hospital, Uganda. Participants were randomised into either a standard Lichtenstein repair group or a standard Lichtenstein with Iliohypogastric neurectomy group. The participants and outcome assessors were blinded to the treatment method. The outcome variables were; postoperative pain, assessed for with a Visual Analogue Scale at different time intervals; mean pain scores at rest and following activity. Statistical analysis was done with STATA 10 and GENSTAT. A two sided P-value of less than 0.05 was considered to be statistically significant. Results: There was a statistically significant difference in Mean Pain Score at 2hours postoperatively between the standard Lichtenstein Repair(0.957) and the Lichtenstein with Iliohypogastric neurectomy(0.34), p<0.001. There was less Task Induced Pain in the Lichtenstein with Iliohypogastric neurectomy group (0.140) compared to the Standard Lichtenstein group(0.739), p<0.001. Conclusion: Iliohypogastric neurectomy is a safe and effective method of reducing postoperative pain in Lichteistein Hernia repair.