Prophylactic neurectomy versus nerve preservation in open inguinal hernia repair for prevention of chronic postoperative inguinal pain (CPIP): a systematic review and meta-analysis.
Mingxing Liu, Wenbo Gui, Sihua Wen et al.
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In 30 seconds
This systematic review and meta-analysis assessed prophylactic neurectomy versus nerve preservation in adults undergoing elective open anterior inguinal hernia repair, including 17 randomized trials. At longest follow-up, chronic postoperative inguinal pain was reported in 9.3% after neurectomy and 18.1% after preservation (RR, 0.37; 95% CI, 0.25-0.55; I² = 69.2%). Neurectomy was also associated with more sensory loss or change, while moderate-to-severe pain remained statistically uncertain. Quality of life, recurrence, and surgical complications did not differ meaningfully. The authors conclude that limitations and heterogeneity do not support routine neurectomy.
Key findings
- At longest follow-up, chronic pain occurred in 9.3% after neurectomy versus 18.1% after preservation (RR, 0.37; 95% CI, 0.25-0.55; I² = 69.2%).
- Neurectomy was associated with increased sensory loss or change, although groin numbness was similar between groups.
- Acute pain and rescue analgesic use were lower after neurectomy; quality of life, recurrence, and surgical complications did not differ meaningfully.
- The effect on moderate-to-severe chronic pain remained statistically uncertain.
Why it matters
Chronic pain is an important source of disability after open inguinal hernia repair, and the pooled results suggest prophylactic neurectomy may reduce its occurrence. However, the sensory trade-off and absence of measurable quality-of-life benefit complicate interpretation. The findings highlight the need to weigh pain outcomes against sensory effects and to recognize that the available trials do not establish which patients might benefit.
What to keep in mind
The review reports methodological limitations, heterogeneity, and incomplete reporting of nerve identification in control procedures. Trials could not identify patients most likely to benefit.