Nerve-Identifying Inguinal Hernia Repair: A Surgical Anatomical Study

Wijsmuller, A. R.; Lange, J. F. M.; Kleinrensink, G. J.; van Geldere, D.; Simons, M. P.; Huygen, F. J. P. M.; Jeekel, J. F.
February 2007
World Journal of Surgery;Feb2007, Vol. 31 Issue 2, p414
Academic Journal
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. 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). 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. 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.


Related Articles

  • Does nerve identification during open inguinal herniorrhaphy reduce the risk of nerve damage and persistent pain? Bischoff, J.; Aasvang, E.; Kehlet, H.; Werner, M. // Hernia;Oct2012, Vol. 16 Issue 5, p573 

    Purpose: Nerve identification during open inguinal hernia herniorrhaphy has been suggested as one of the factors that may reduce the risk of development of persistent postherniorrhaphy pain. In this prospective study, we evaluated whether intraoperative inguinal nerve identification influenced...

  • Neuralgie des N. genitofemoralis nach Hernioplastik. J. Walter; R. Reichart; C. Vonderlind; S.A. Kuhn; R. Kalff // Der Chirurg;Aug2009, Vol. 80 Issue 8, p741 

    Zusammenfassung  Die periphere Nervenstimulation (PNS) hat sich in der Behandlung neuropathischer Schmerzen etabliert. In diesem Fall wird die erfolgreiche epifasziale Stimulation im Bereich des N. genitofemoralis beschrieben. Dieser wurde durch eine endoskopische Hernioplastik...

  • The transinguinal preperitoneal hernia correction vs Lichtenstein's technique; is TIPP top? Koning, G. G.; Koole, D.; de Jongh, M. A. C.; de Schipper, J. P.; Verhofstad, M. H. J.; Oostvogel, H. J. M.; Vriens, P. W. H. E. // Hernia;Feb2011, Vol. 15 Issue 1, p19 

    Background: Chronic pain is the main drawback of the Lichtenstein procedure for inguinal hernia repair, with a reported incidence of 15-40%. The transinguinal pre-peritoneal (TIPP) technique seems to be associated with less chronic pain, comparable to the total extra peritoneal (TEP) technique....

  • A Minor Modification of Lichtenstein Repair of Primary Inguinal Hernia: Postoperative Discomfort Evaluation. FRICANO, SALVATORE; FIORENTINO, EUGENIO; CIPOLLA, CALOGERO; MATRANGA, DOMENICA; BOTTINO, ALESSANDRO; MASTROSIMONE, ACHILLE; BONANNO, ENRICO; LATTERI, MARIO ADELFIO // American Surgeon;Jul2010, Vol. 76 Issue 7, p764 

    The aim of this study was to evaluate the usefulness of a modification of the Lichtenstein hernioplasty procedure by evaluating its impact on postoperative discomfort. From December 1999 to May 2006, the Lichtenstein inguinal hernioplasty was performed in 406 patients with noncomplicated...

  • Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Miserez, M.; Peeters, E.; Aufenacker, T.; Bouillot, J.; Campanelli, G.; Conze, J.; Fortelny, R.; Heikkinen, T.; Jorgensen, L.; Kukleta, J.; Morales-Conde, S.; Nordin, P.; Schumpelick, V.; Smedberg, S.; Smietanski, M.; Weber, G.; Simons, M. // Hernia;Apr2014, Vol. 18 Issue 2, p151 

    Purpose: In 2009, the European Hernia Society published the EHS Guidelines for the Treatment of Inguinal Hernia in Adult Patients. The Guidelines contain recommendations for the treatment of inguinal hernia from diagnosis till aftercare. The guidelines expired January 1, 2012. To keep them...

  • Transinguinal preperitoneal groin hernia repair using a preperitoneal mesh preformed with a permanent memory ring: a good alternative to Lichtenstein's technique. Maillart, J. F.; Vantournhoudt, P.; Piret-Gerard, G.; Farghadani, H.; Mauel, E. // Hernia;Jun2011, Vol. 15 Issue 3, p289 

    Purpose: The transinguinal preperitoneal (TIPP) technique uses a preperitoneal mesh preformed with a permanent memory ring, which greatly facilitates application of Rives' technique. The purpose of this retrospective study was to evaluate our primary results by systematic clinical and ultrasound...

  • Lightweight mesh and noninvasive fixation: an effective concept for prevention of chronic pain with laparoscopic hernia repair (TAPP). Bittner, Reinhard; Gmähle, Eliza; Gmähle, Björn; Schwarz, Jochen; Aasvang, Eske; Kehlet, Henrik // Surgical Endoscopy;Dec2010, Vol. 24 Issue 12, p2958 

    Background: This prospective study aimed to evaluate the impact of transabdominal preperitoneal patch plasty (TAPP) with implantation of a lightweight mesh (<50 g/m²) fixed by fibrin glue on the occurrence of chronic pain and sexual dysfunction in hernia patients. Methods: Patients were...

  • Risk Factors for Chronic Pain after Open Ventral Hernia Repair by Underlay Mesh Placement. Rosin, Danny // World Journal of Surgery;Jul2012, Vol. 36 Issue 7, p1555 

    The author discusses the study conducted by C. Gronnier and colleagues on the postoperative pain after ventral hernia repair operation. The author says that Gronnier and colleagues used the open underlay mesh repair approach, which is practiced by laparoscopically by many surgeons. He mentions...

  • Neurophysiological characterization of persistent pain after laparoscopic inguinal hernia repair. Linderoth, G.; Kehlet, H.; Aasvang, E.; Werner, M. // Hernia;Oct2011, Vol. 15 Issue 5, p521 

    Purpose: About 2-5% of patients undergoing laparoscopic inguinal repair experience persistent pain influencing everyday activities. However, compared with persistent pain after open repair, the combined clinical and neurophysiological characteristics have not been described in detail. Thus, the...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics