Which nerves in the groin are potentially at risk for damage?


The risk of nerve damage during inguinal hernia repair that may have any serious consequences is low. The named nerves encountered in an open anterior inguinal herniorrhaphy are the ilio-inguinal, the genital branch of the genitofemoral nerve and the ileo-hypogastric. These are skin sensory nerves that do not effect sexual function. Injury to any of these nerves causes patches of numbness in the groin and upper inner thigh. This numbness does however eventually go away as the nerves grow back over a long period of time. The femoral nerve is also in the vicinity below the inguinal ligament and lateral to the femoral artery. Injury to the femoral nerve is rare and I have never seen such an injury.

One great misunderstanding about the role of nerves in chronic pain related to hernia mesh is that some how the nerves can be avoided. The named nerve branches, such as the three named above branch, and branch and rebranch into a very fine network of microscopic nerve fibers that have pain receptors called nociceptors covering virtually every square centimeter of the groin. It is not possible to avoid pain receptors when mesh is plastered into the groin.

Some surgeons advocate dissecting and retracting nerves out of the repair field. I simply identify and avoid named branches without dissecting. It is impossible to totally prevent nerve involvement in mesh. Some mesh hernia surgeons are advocating triple neurectomy at the time of mesh hernia repair. In pure tissue repairs it is very easy to avoid named branches.

Mesh causes chronic inflammation in a wide field which stimulates pain receptors. Pure tissue repairs do not cause chronic inflammation.



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