一般診療ジャーナル

Postoperative Pain in Lichtenstein Repair with Iliohypogastric Neurectomy Compared to Standard Lichtenstein Repair, for Inguinal Hernias at Mulago Hospital, A Sub Saharan Africa Tertiary Centre

Abstract

Francis Basimbe, Peter A Ongom, Stephen C Kijjambu and Olivia Kituuka

Introduction: Groin hernias comprise a large proportion of the surgical volume, worldwide. Inguinal hernia repair is possibly the commonest general surgical procedure. In recent years, greater focus has been put on the quality-of-life of the patient, using postoperative pain as an indicator. Iliohypogastric neurectomy has been shown to significantly reduce postoperative pain. It was considered necessary to evaluate the effectiveness of iliohypogastric neurectomy in day surgery at a tertiary hospital, in a low income country. A study to compare the short-term and medium-term postoperative pain following Lichtenstein hernia repair, with and without iliohypogastric neurectomy, was conducted. Methods: It was a double-blinded randomized parallel clinical trial. A total of 96 patients, out of 106 eligible patients, with primary inguinal hernias were recruited in Mulago National Teaching and Referral Hospital’s Surgical Outpatient Department, Kampala, Uganda. Participants were randomized into either a standard Lichtenstein repair group (46 patients) or a standard Lichtenstein repair with iliohypogastric neurectomy group (50 patients), and underwent day surgery. The participants and outcome assessors were blinded to the treatment method. Outcome variables were postoperative mean pain scores at rest and following activity. Pain assessment was done with the Visual Analogue Scale at different time intervals; 2 hrs, 7 days and 28 days postoperative. Results: There was a significant difference in mean pain scores between the standard. Lichtenstein repair (0.957) and the Lichtenstein repair with iliohypogastric neurectomy (0.34) groups (P<0.001). There was less taskinduced pain in the Lichtenstein repair with iliohypogastric neurectomy group (0.140) compared to the standard Lichtenstein repair group (0.739) (P<0.001). Conclusion: Postoperative pain in Lichtenstein repair with iliohypogastric neurectomy is less in comparison to Lichtenstein repair alone, in the treatment of inguinal hernias. Iliohypogastric neurectomy is thus an effective method of controlling postoperative pain in Lichtenstein hernia repair.