The ilioinguinal nerve traverses the inguinal canal and supplies sensory innervation to the upper medial thigh, scrotum or labium majus, and root of the penis or mons pubis. It is the nerve most commonly injured in inguinal hernia repair, either directly during the repair or by entrapment in the mesh material, producing chronic groin and scrotal pain (ilioinguinal neuralgia) that is one of the most challenging complications of herniorrhaphy.
| Origin | Lumbar plexus (L1) |
|---|---|
| Course | Emerges from the lateral border of psoas below the iliohypogastric nerve, crosses quadratus lumborum and iliacus, pierces transversus abdominis and internal oblique near the anterior part of the iliac crest, traverses the inguinal canal anterior to the spermatic cord (or round ligament) and exits through the superficial inguinal ring |
| Motor |
|
| Sensory |
|
Post-herniorrhaphy inguinal neuralgia from ilioinguinal nerve injury produces chronic burning groin pain, scrotal or labial numbness and sometimes hyperalgesia that can seriously affect quality of life. Higher up, the nerve can also be injured in retroperitoneal and lateral lumbar spine approaches, iliac crest bone graft harvest and low transverse abdominal incisions. Management includes neuropathic pain medication, targeted nerve blocks and radiofrequency treatment, and triple neurectomy (ilioinguinal, iliohypogastric and genitofemoral) helps most refractory cases.
Ilioinguinal nerve damage during hernia repair producing chronic groin and scrotal pain managed with nerve blocks and triple neurectomy for refractory cases.
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