Prophylactic neurectomy versus nerve preservation in open inguinal hernia repair for prevention of chronic postoperative inguinal pain (CPIP): a systematic review and meta-analysis.

purposeChronic 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.

methodsPubMed, 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.

resultsSeventeen 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.

conclusionProphylactic 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.