Page 60 - herina surgery and possible lawsuits

on chronic pain, but they found sensory disturbances in division group [123, 124], Other

study recommend prophylactic neurectomy at the time of surgery associated with less chronic
pain. [125] Although it seems intuitive that a suture tied down on a nerve would cause pain,
this has not been studied in any scientific manner. [72]

• Alfieri et al reported moderate to severe pain at 6 months after hernia surgery in

1.3% when all nerve identified,

1.1% when 1 nerve not identified,
2.8% when 2 nerves not identified,
4.7% when all nerves not identified

1.7% when all nerve identified, but 1 or 2 nerves divided or injured
40% when all nerve identified and divided.
The analysis found statistical difference (P=0.02) between that lack of identification

of nerves with the presence of chronic pam. The risk of developmg inguinal pain
increasing with the number of nerves concomitantly not detected and the division of
nerves was strongly correlated with the presence of chronic pain, thus they strongly

stress the importance of always identifying and preserving all 3 nerves of the inguinal
during hernia. [43]

• Picchio et al m their double-blind, randomized controlled trial of preservation or
elective division of ilioinguinal nerve on 813 open inguinal meshplasty, found chronic

pam in 23.5% and 27% respectively at 1 year. They conclude that pain not affected by
elective division of the ilioinguinal nerve, but sensory disturbances in the area of
distribution of the transected nerve are significantly more.[123] The neurologic deficit
is minimal and consists of a loss of cremasteric reflex and an area of anesthesia of the

inguinoscrotal fold no larger than 3 cm to 5 cm m diameter.
• Tons observe red common nerve likely to get injured is genitofemoral nerve, the
incidence of chrome pam reduced by preserving it, and if necessary elective division

to reduces chance of entrapment syndromes. [126]
• Bartelett study, ilioinguinal, iliohypogastric and genital nerves identified and either of
them divided and compared with preservation of nerve. They found no difference on

pain score of nerve division group and suggested practical approach of nerve division
when they are at risk of damage. [20]
• In contrast, Mui et. al in similar study design found 28.6% and 8% (P=0.008) and

concluded that prophylactic ilioinguinal neurectomy significantly decreases the
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