Groin Pain Update

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Identification Zones for the Inguinal Nerves

• The iliohypogastric nerve : 3.8 cm (range 2.5–5.5 cm) cranially from the external ring.

• The ilioinguinal nerve : ventrally and parallel to the spermatic cord, dorsally from the aponeurosis of the external oblique muscle.

• The genital branch : laterocaudal at the level of the internal inguinal ring.

Nerve-Identifying Inguinal Hernia Repair: A Surgical Anatomical StudyA. R. Wijsmuller, J. F. M. Lange, G. J. Kleinrensink, D. van Geldere, M. P. Simons,F. J. P. M. Huygen, J. Jeekel, J. F. Lange World J Surg (2007) 31: 414–420

Identification Zones for the Inguinal Nerves

• 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.

• The ilioinguinal nerve was identifiable running ventrally and parallel to the spermatic cord, dorsally from the aponeurosis of the external oblique muscle.

• The course of the genital branch is laterocaudal at the level of the internal inguinal ring.

The Iliohypogastric • In the case of difficulty

identifying the iliohypogastric nerve, the upper leaf of the external oblique aponeurosis should be separated medially and cranially and lifted cautiously until the iliohypogastric nerve is identified perforating the aponeurose at a zone 2.5–5.5 cm (3.8 cm) cranial from the external ring .

The genital branch

• The genital branch of the genitofemoral nerve should be identified proximally and laterocaudally at the level of the internal ring in the frontal plane where its course variability is least.