Prophylactic neurectomy versus nerve preservation in open inguinal hernia repair for prevention of chronic postoperative inguinal pain (CPIP): a systematic review and meta-analysis
In brief
Nerve removal was linked to chronic pain rates of 9% vs 18%
Across 17 randomized trials, planned removal of one or more groin nerves was associated with chronic pain in about 9% of patients, compared with 18% when nerves were preserved. Sensory loss or change increased, but quality of life, recurrence, and complications did not meaningfully differ; study limitations leave unclear who benefits, so routine use is not supported.
- Journal
- Hernia : the journal of hernias and abdominal wall surgery (Q1)
- Published
- 23 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Mingxing Liu, Wenbo Gui, Sihua Wen, Min Zhou
- PMID
- 42909669
- DOI
- 10.1007/s10029-026-03859-5
Why clinicians should know about it
- Picked for Surgery (top studies of the week, 25 October 2026): Randomized-trial evidence on chronic pain prevention after inguinal hernia repair
Abstract
PURPOSE: Chronic postoperative inguinal pain remains an important source of disability after open inguinal hernia repair. The review evaluated whether planned prophylactic neurectomy reduces chronic pain compared with nerve preservation in adults undergoing elective open anterior repair. METHODS: PubMed, Scopus, Web of Science, Cochrane CENTRAL, and Ovid MEDLINE were searched from January 2000 through March 2026. Randomized controlled trials comparing intentional neurectomy of one or more inguinal nerves with preservation during open anterior repair were eligible. Two reviewers independently selected studies, extracted data, and assessed risk of bias using RoB 2. Random-effects models pooled risk ratios and standardized mean differences. RESULTS: Seventeen randomized trials were included. At the longest follow-up, chronic postoperative inguinal pain occurred in 166 of 1779 participants after neurectomy and 294 of 1627 after preservation (9.3% vs. 18.1%; RR, 0.37; 95% CI, 0.25-0.55; I² = 69.2%). Associations favored neurectomy at 3, 6, and 12 months or longer. Moderate-to-severe chronic pain remained statistically uncertain. Sensory loss or change increased, while groin numbness remained similar. Acute pain and rescue analgesic use were lower. Health-related quality of life, recurrence, and surgical complications did not differ meaningfully. CONCLUSION: Prophylactic neurectomy was associated with less chronic pain but more sensory disturbance and no measurable quality-of-life benefit. Incomplete reporting of nerve identification in control procedures, methodological limitations, and heterogeneity preclude routine use. Existing trials could not identify patients most likely to benefit.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.