Is it really necessary to open the external oblique aponeurosis in performing open inguinal herniotomy ?

- not needed in neonatal / infant herniotomy, needed in older children

or performing inguinal herniotomy via the external ring is equally effective ? and does that ( opening the inguinal canal ) really increase that risk of Ilioinguinal nerve injury ?

- Herniotomy is effective without opening the aponeurosis only in neonates /younger infants. There is no increase in risk of nerve injury

is there any increased risk of recurrence if done via the external oblique ?

- No