Sites & consequences of potential nerve injury in inguinal hernia repair
•Nerve entrapment is very “patient dissatisfying” complication of inguinal hernia repair despite the relatively low occurrence, reported between 1 and 5% in the surgical literature. If an injury to a nerve were to happen during an 𝗼𝗽𝗲𝗻 approach for surgical repair of a hernia, the 𝗺𝗼𝘀𝘁 𝗰𝗼𝗺𝗺𝗼𝗻𝗹𝘆 (2%) injured nerve is the 𝗶𝗹𝗶𝗻𝗴𝘂𝗶𝗻𝗮𝗹 𝗻𝗲𝗿𝘃𝗲 followed by the iliohypogastric nerve. Injury related to an open inguinal hernia repair often results in symptomatology in the distribution over the groin scrotum as seen in Fig. 2.9.
•The laparoscopic approach, because of the posterior nature of the dissection, has a much lower risk for injury to the ilioinguinal and iliohypogastric nerve. The 𝗺𝗼𝘀𝘁 𝗰𝗼𝗺𝗺𝗼𝗻𝗹𝘆 injured nerve during a 𝗹𝗮𝗽𝗮𝗿𝗼𝘀𝗰𝗽𝗼𝗶𝗰 technique for repair is the 𝗹𝗮𝘁𝗲𝘁𝗮𝗹 𝗳𝗲𝗺𝗼𝗿𝗮𝗹 𝗰𝘂𝘁𝗮𝗻𝗲𝗼𝘂𝘀 𝗻𝗲𝗿𝘃𝗲. This area of symptomatology is more anterior thigh in nature differently between open and laparoscopic operative approaches.
Because of the complexity of the inguinal region with its muscles, fascia, nerves, blood vessels, and spermatic cords, it is essential that the general surgeon be comfortable with the anatomy viewed from the direction of the surgeon’s operative choice. Understanding the anatomy for this commonly performed surgery is important in choosing the best, patient-tailored, operative technique with the lowest complications & lowest recurrence rates.