Authors’ Reply: Ilioinguinal Nerve Neurectomy is better than Preservation in Lichtenstein Hernia Repair: A Systematic Literature Review and Meta-analysis

It is a sincere pleasure for us that interested and expert readers drawn to our attention some observations con-cerning our paper (“Ilioinguinal Nerve Neurectomy is better than Preservation in Lichtenstein Hernia Repair: A Systematic Literature Review and Meta-analysis”) [1]. As reported from Aiolfi et al., one of the most important bias of the included RCTs and common clinical practice of hernia surgery is the identification of all inguinal nerves. In a recent systematic review and meta-analysis on 5265 half-body examinations, the identification rate of the ilioin-guinal nerve (IIN) was 94.4% (95% CI 89.5–97.9) using a random-effects model; the identification rates of the ilio-hypogastric nerve (IHN) and genitofemoral nerve (GNF) were 86.7% (95% CI 78.3–93.3%) and 69.1% (95% CI 53.1–83.0%) [2]. An expertise in surgical anatomy can facilitate intraoperative identification of inguinal nerves and reduce the risk of their iatrogenic or prosthetic injury associated with chronic post-operative groin pain. More-over, in our meta-analysis, the subgroup analysis of the studies that identified the IIN shows that one of the risk factors identified (not reported identification of IIN) does not modify the trend in favor of the neurectomy (RR 0.28, 95% CI 0.13–0.63, p = 0.002).