Cutting the groin nerves halves chronic pain, at a sensory cost

The edition in brief

A meta-analysis of 17 randomised trials of open anterior inguinal hernia repair found planned neurectomy reduced chronic postoperative inguinal pain from 18.1% to 9.3% (RR 0.37, 0.25–0.55) but increased sensory disturbance, did not clearly reduce moderate-to-severe pain, and did not improve quality of life; the authors advise against routine use. A double-blind trial of 185 patients undergoing laparoscopic sleeve gastrectomy found tranexamic acid reduced intraoperative bleeding (1% vs 5.5%) and kept haemoglobin higher, with no thrombotic events but no change in transfusion. A Japanese multicentre randomised trial found a powdered cross-linked chondroitin sulfate barrier reduced adhesions under the incision after open rectal resection from 93% to 45% at stoma closure. A Danish nationwide survey of 2,348 patients after incisional hernia repair found onlay mesh was associated with more foreign-body sensation than retromuscular mesh, with no difference in chronic pain or recurrence.