Inguinal hernia repair: can one identify the three main nerves of the region?

OBJECTIVE To identify the nerves in the groin during inguinal hernia repair by inguinotomy. METHODS We conducted a prospective, sequenced, non-randomized study comprising 38 patients undergoing inguinal hernia repair with placement of polypropylene mesh. RESULTS The male patients were 36 (94.7%), with a mean age and standard deviation of 43.1 ± 14.5, body mass index of 24.4 ± 2.8. Comorbidities were hypertension in two (5.2%), smoking in 12 (31.5%) and obesity in two (5.2%). The hernia was located only on the right in 21 (55.2%) patients, only on the left in 11 (28.9%), and was bilateral in six (15.7%) patients. Prior hernia repair was present in seven (18.4%) patients. The identification of the three nerves during operation was made in 20 (52.6%) patients, the ilioinguinal nerve and the iliohypogastric nerve were identified in 33 (86.8%), and the genital nerve branch of the genitofemoral nerve, in 20 (52.6%). Resection of at least one of the nerves was performed in seven (18.4%) cases, two iliohypogastric nerves and five ilioinguinal nerves. The average operating time was 70.8 ± 18.2 minutes. The hospital stay was 1.42 ± 1.18 days. Ten patients (26.3%) returned to physical activity around the first postoperative visit, and 37 (97.3%) in the last. The follow-up time was 95.6 ± 23.5 days. The inability to identify the ilioinguinal nerve was associated with previous repair (p = 0.035). CONCLUSION The identification of the three nerves during inguinal hernia surgery has been described in more than half of the cases and prior repair interfered with the identification of ilioinguinal nerve.