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Nerve-Identifying Inguinal Hernia Repair: A Surgical Anatomical Study

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Abstract

Background

Pain syndromes of somatic and neuropathic origin are considered to be the main causes of chronic pain after open inguinal hernia repair. Nerve-identification during open hernia repair is suggested to be associated with less postoperative chronic pain. The aim of this study was to define clinically relevant surgical anatomical zones facilitating efficient identification of the three inguinal nerves during open herniorrhaphy.

Method

Through dissection of 18 inguinal areas of embalmed and unembalmed human cadavers, identification zones were developed for the inguinal nerves (in particular for the genital branch of the genitofemoral nerve).

Results

The iliohypogastric nerve was identifiable running approximately horizontally and ventrally to the internal oblique muscle perforating the external oblique aponeurosis at a mean of 3.8 cm (range 2.5–5.5 cm) cranially from the external ring. When present, the ilioinguinal nerve was identifiable running ventrally and parallel to the spermatic cord, dorsally from the aponeurosis of the external oblique muscle. Identification of the genital branch of the genitofemoral nerve was more comprehensive. The course of the genital branch is laterocaudal at the level of the internal inguinal ring.

Conclusion

Based on the newly defined identification zones, peroperative identification of all inguinal nerves is possible. Further research is warranted to assess clinical feasibility of these zones and to evaluate the influence of (facultative) division, preservation or omittance of the identification of inguinal nerves on the incidence of chronic pain.

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Acknowledgements

The authors thank Dr. J.C. den Hollander of the Department of Pathology for assistance with the production of the histological images.

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Authors and Affiliations

  1. Department of Surgery, Erasmus MC, University Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands

    A. R. Wijsmuller, J. Jeekel & J. F. Lange

  2. Department of Surgery, Isala Clinics, Zwolle, The Netherlands

    J. F. M. Lange & D. van Geldere

  3. Department of Neurosciences, Erasmus MC, University Medical Center, Rotterdam, The Netherlands

    G. J. Kleinrensink

  4. Lowlands Institute of Surgical and Applied Anatomy, Rotterdam, The Netherlands

    G. J. Kleinrensink & J. F. Lange

  5. Department of Surgery, Onze Lieve Vrouwe Gasthuis, University of Amsterdam, Amsterdam, The Netherlands

    M. P. Simons

  6. Pain Treatment Center, Department of Anesthesiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands

    F. J. P. M. Huygen

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  1. A. R. Wijsmuller
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Correspondence to J. F. Lange.

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Wijsmuller, A.R., Lange, J.F.M., Kleinrensink, G.J. et al. Nerve-Identifying Inguinal Hernia Repair: A Surgical Anatomical Study. World J. Surg. 31, 414–420 (2007). https://doi.org/10.1007/s00268-006-0376-y

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