A tension-free mesh repair of an indirect inguinal hernia is performed via the Lichtenstein technique. Which nerve, running within the inguinal canal superficial to the spermatic cord, is at greatest risk of injury causing chronic inguinodynia (post-herniorrhaphy pain)?

• A Genital branch of the genitofemoral nerve
• B Iliohypogastric nerve
• C Ilioinguinal nerve ✓
• D Lateral femoral cutaneous nerve

Explanation

The ilioinguinal nerve traverses the inguinal canal running on the anterior surface of the spermatic cord and exits through the superficial inguinal ring to supply the medial thigh, scrotum, and base of penis. During Lichtenstein repair, it is the nerve most commonly injured (trapped in mesh or sutured), leading to chronic post-herniorrhaphy inguinodynia. The iliohypogastric nerve runs above the internal oblique and can be injured at the medial fixation sutures. The genital branch of the genitofemoral nerve runs with the spermatic cord but is less commonly implicated in chronic pain.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.