The standard procedure I perform is modified Trabucco's operation.

I use to preserve carefully all the three nerves especially during the dissection of the sac. Another step dangerous to the nerves is the reconstruction of the oblique fascia to cover the mesh: it is necessary to be careful not to involve the nerve in the suture.

You should have a look in the recent work from Wolfgang Reinpold, Hamburg Germany:

Reinpold WM et al. Nerve management and chronic pain after open inguinal hernia repair: a prospective two phase study. Ann Surg. 2011 Jul;254(1):163-8.

Giuseppe Pappalardo, La Sapienza, University of Rome

http://Since the beginning of the last decade I published the results of my experience in preventing persistent post-hernirrafhy pain, stressing the importance of neurectomy. My last publication on this item is on World.J.Surg, 2007; 31/5): 1081-6.I favour neurectomy of hilio-hypogastric nerve and neurectomy of the other 2 nerves only in case of intraoferative damage.-

Usually I preserve the three nerves. I cut only when they are in the operative field.

Obviously every surgeon saves them as a rule. I may severe branches of genitofemoral, however, inadvertently. If I cut a nerve in this area I trim it proximal enough, by cautery, so that it retracts within deep tissue trying to reduce neuroma formation which is more trouble some than numbness. I take meticulous care to avoid including nerve trunks or branches within repair sutures or ligatures. I believe it results in chronic pain(-odynia and -algia), as it happens when laparoscopic mesh tackers catch the iliohypogastric nerve.

Since I started using the technique ONSTEP, I stopped worrying about nerve injuries or chronic pain.

Usually I try to identify and preserve all three inguinal nerves during open inguinal hernia repair. I never use elective resection of normal inguinal nerves and use neurectomy of only in cases of it injury or hight risk of neuroma formation.

In my opinion routine identification and preservation of nerves is the best method for prevention of chronic postoperative inguinal pain or postoperative nerve entrapment. Elective inguinal neurectomy or neurolysis (that is the questions !) should be suggested only for patients with chronic ( at least 1 year from the operation) post-herniorrhaphy pain who don't respond to conservative (no-surgery) treatment.

It is extremely rare to injure or damage the nerves during surgery. I carefully identify them and protect them during surgery. If they are injured anyway during surgery or operative field is very much limited due to location of nerve, they can be sacrificed in my opinion.

In my opinion,one should clearly identify and thus preserve the nerves during dissection in the area.However in around 40-45 percent of patients, the course of ileoinguinal and ileohypogastric nerves is anatomically consistent as referred in most anatomical books and in others it varies which makes identification difficult in some.But the identification still carries benefit in a good cohort of patients.Lap repair also reduces its incidence to some extent.

Thank you for this interesting question! It highlights that inguinal hernia repair without tension (and with one as well) remains a problem. Actually, what a matter of concern are not only persistent pain, but azoospermia, discomfort in the inguinal region, etc., that not seldom follow this kind of operations.

I do not use and cannot recommend a nerve cut in Nyhus-I, II, and III in elective procedure patients.

Of importance, that a mesh should not be in direct contact with the nerves aforemenshioned lest it will become involved in a future scar tissue and so that to become a sourse of future pain.

A surgeon should not left heamatomas or seromas overlooked because they will turn into scar tissue and become the source of future pain also.

A surgeon should avoid draine tubes of any kind as frequent as only possible because the drain wound will become infected, and the whole process will finish at last with hideous fibrous deformity of neighbour tissues.

A surgeon should use as light mesh as possible. On the contrary, a heavy rough mesh will cause a sole-quality mass formation that may diminish patient quality of life.

In case of Nyhus-IV hernia, cut or cut not depends on the given nerve condition and from... chance, for it is very dufficult to identify a nerve trunk in scar tissue sometimes. Honestly to say, in many times.

I have never read or heard about that electrosensor device which surgeon-endocrinologists use commonly for the nervus recurrens identification, that it has been used once in Herniology. I like this idea and recall it any time when I make Nyhus-IV. Afterwards... I forget it till the next time.

during an open antereior inguinal hernia repair, you must coagulating the ileoinguinal nerve at least for an inch long, avoid to entrap the ileo ipogastric nerve with any kind of suture and absolutely respect the genital nerve (don't touch it!). This is the recipt for a dramatic lowering of the post herniorraphy neurophaty

Short remark to the recommendations of Professor Giorgio Vasquez. I believe that during the open antereior inguinal hernia repair is possible sometimes to coagulate the ileoinguinal nerve (if indicated or as appropriate). But I think that advice always to cross it (must) is a bit categorical. Especially, taking into account a different clinical experience of auditorium. At such approach all patients will always have a dysfunctional neurological disorders, while preserving nerve and precision surgical technique allows the development of the phenomenon of ileoinguinal nerve entrapment only in rare cases.

I agre Igor Geryc , I preserve ,when it's possible, nerve .

Of course, it is your decision, cut IIN or cut not. However, might be useful to read this first:

The ilioinguinal nerve is a branch of the first lumbar nerve (L1). .... The ilioinguinal nerve then perforates the transversus abdominis near the anterior part of the iliac crest, then goes the obliquus internus through, distributing filaments to it, and then accompanies the spermatic cord on the level of the superficial inguinal ring where Its fibers are then distributed to the skin of the upper and medial part of the thigh, and to the following locations:

In the male ("anterior scrotal nerve"): to the skin over the root of the penis and upper part of the scrotum.

In the female ("anterior labial nerve"): to the skin covering the mons pubis and labium majus.

In case you choose the penis root anesthesia, cremaster reflex arrest, and azoospermia on the operation site, cut it always without any doubt! It would be quite painless...

All three nerves mentioned above have specific functions to serve. Division of these nerves can lead to intractable symptoms in some patients, although not in everybody. It is impossible to predict at the time of surgery who are going to be the victims of deliberate or inadvertent neurectomy. I, personally, preserve all nerves carefully in every patient and do not see problems afterwards.Time flies very fast; good 28 years have flown since I started doing hernia repairs !!!!!