One review investigated surgical management of chronic pain after inguinal hernia repair (examining neurectomy and mesh, or staple removal, as possible treatments) (Aasvang & Kehlet, 2005; LoE 1):
- Neurectomy of the ilioinguinal, genitofemoral or lateral femoral cutaneous nerve was associated with a favourable outcome (Aasvang & Kehlet 2005; LoE 1)
- There was not enough evidence available on the effect of mesh or staple removal (Aasvang & Kehlet 2005; LoE 1).
A second review investigated the incidence, severity and consequences of chronic pain after mesh repair of inguinal hernia (Nienhuijs 2007; LoE 1):
- It was found that 11% of patients suffer chronic pain after mesh-based inguinal hernia repair, and that almost one third of patients had limitations in daily leisure activities as a consequence of chronic pain (Nienhuijs 2007; LoE 1).
- It was also reported that chronic pain is less frequent following endoscopic procedures or the use of a lightweight mesh (Nienhuijs 2007; LoE 1).
A third review identified the studies investigating the influence of different types of nerve management during hernia repair (Wijsmuller 2007; LoE 1):
- Analyses of pooled data from three randomised studies showed that the proportion of patients with chronic pain following ilioinguinal nerve identification and division, was similar to that after ilioinguinal nerve identification and preservation (Wijsmuller 2007; LoE 1)
- Two cohort studies found that the incidence of chronic pain was significantly lower after identification of ilioinguinal nerve versus no identification of ilioinguinal nerve (Wijsmuller 2007; LoE 1)
- Another cohort study found that the incidence of chronic pain was significantly lower after identification and division of the genital branch of the genitofemoral nerve versus no identification at all (Wijsmuller 2007; LoE 1)
- The review concluded that nerves should be identified during open hernia repair, but that division and preservation of the ilioinguinal nerve showed similar chronic pain results (Wijsmuller 2007; LoE 1)