Neurosensory Alterations Following Anterior Open Inguinal Hernioplasty: An Inconvenient Truth

Aim Neurosensory dysfunction represents a prevalent complication after open inguinal hernia repair. Nevertheless, the prevalence study of hypoesthesia and chronic neuropathic postoperative inguinal pain (CPIP) remains deficient. The principal objective of this prospective observational investigation is to ascertain the incidence of neurosensory aberrations within the first post-surgery year, employing the dermatome mapping test as the primary assessment modality, while concurrently assessing the trajectory of these manifestations and their enduring presence. Material and Methods A total of 129 patients, who underwent inguinal hernia mesh repair (Lichtenstein tension-free mesh repair) between January 2020 and January 2022, were included in this prospective observational study. All patients were assessed at 30 days, 6 months, and 1 year postoperatively using the dermatome mapping test. Results At 30 days, the rate of sensory alteration for the ilioinguinal (II), Iliohypogastric (IH), and genitofemoral (GF) nerves was 57.3%, 11.6%, and 45%, respectively, with a rate of chronic neuropathic pain (CPIP) of 10%, 3.1%, and 7%. At 6 months, it was 35.6%, 2.3%, and 32%, with a CPIP rate of 4.6% for the II nerve. Finally, at one year, it was 20.9%, 1.5%, and 10.8%, with a persistent CPIP rate of 4.6% for the II nerve. Conclusions Sensory alteration (hypoesthesia or CPIP) is the most common long-term complication following open anterior inguinal hernia surgery, with significant rates affecting up to 1 in 5 patients for the ilioinguinal territory, and 1 in 10 for the genitofemoral territory one year after surgery. These results raise questions about whether other surgical techniques, such as the open posterior approach (Nyhus) or laparoscopic or endoscopic surgery (TAPP and TEP), can reduce or prevent these long-term alterations. The dermatome mapping test is a tool that helps us detect these alterations in an easy and effective manner, and it should be systematically performed in postoperative evaluations of all inguinal hernia surgeries.