Impact of different neurectomy techniques on managing chronic pain after inguinal hernia repair: a meta-analysis and systematic review

Purpose This meta-analysis aims to analyze the outcomes of neurectomy for treating chronic post herniorrhaphy pain (CPIP), with a focus on the efficacy of various surgical approaches (open, laparoscopic transabdominal, endoscopic retroperitoneal and combined approach), and types of neurectomy—single, double and triple. Methods The research was registered with PROSPERO (CRD42023475401). A search in MEDLINE, Embase, Scopus, and Cochrane Central databases was conducted from the inception to November 2023. All participants aged 18 years and older who underwent neurectomy for treating CPIP were included. PRISMA guidelines were followed, selecting only randomized controlled trials, cohort studies and case series. A random-effects model was used for single-arm analyses, while the inverse variance and Mantel-Haenszel methods were employed for two-arm analyses. Results The analysis includes fifteen studies involving 701 patients. Following neurectomy, 90% of the patients experienced an improvement in pain overall. Only 9.4% of the patients had postoperative complications. Among the surgical types, triple neurectomy demonstrated the highest overall pain improvement rate at 98.2%. Double neurectomy showed the highest rate of complete pain relief at 80.1%, but it also had a higher complication rate of 15.3%. In terms of surgical approach, the endoscopic retroperitoneal method not only had the highest overall improvement rate of 95.5% compared to other approaches but also the highest complication rate of 28.7%. Conclusion Neurectomy was shown to be an effective treatment for neuropathic CPIP across various surgical techniques. Randomized controlled trials would be of vital importance to facilitate the evolution of surgical strategy and patient outcomes.