Impact of ilio-inguinal nerve excision on sexual function in open inguinal hernia mesh repair: a prospective follow-up study.

The aim of this study was to prospectively compare sexual function in patients undergoing inguinal hernia surgical repair with or without excision of the ilio-inguinal nerve. Eighty-four patients (76 males and 8 females) with a unilateral inguinal hernia were enrolled in the study. They underwent an open tension free repair with mesh implantation ("plug and patch" technique). The ilio-inguinal nerve was identified and was either preserved (Preservation group, n = 42) or divided (Excision group, n = 42). Patients were asked to answer an anonymous standardised questionnaire about their sexual function pre-operatively, 3 months postoperatively and every 6 months afterwards during the followup. Thirty-two patients (excision group: n = 17 ; preservation group: n = 15 ; p > 0.05) reported pre-operative sexual dysfunction related to the groin hernia. Three months after surgery 19 patients referred a clear improvement of their preoperative complaints. Eleven patients reported new functional problems. About 20% of the patients in both groups reported an improvement of their pre-operative sexual disorders. New sexual functional symptoms were reported significantly more in the preservation group compared to the excision group (21% vs. 7%, p < 0.05). Twenty-four months after surgery the number of patients with functional sexual symptoms was lower in both groups but yet significantly higher in the preservation group. In conclusion, neurectomy of the ilio-inguinal nerve during surgical repair of inguinal hernia could have a favourable influence on sexual function without relevant complications. It causes significantly less sexual problems compared to preservation of the nerve and it is recommended especially for patients with pre-operative sexual dysfunction due to the groin hernia.