Anatomical variations of the ilioinguinal, iliohypogastric, and genitofemoral nerves: a systematic scoping review of cadaver studies.

Aim/background: Nerve management during open inguinal hernia repair is thought to influence the incidence of postoperative chronic pain. Understanding nerve anatomy may assist surgeons in identifying and protecting nerves during surgery. In this study, we aimed to describe the anatomical variations and locations of the ilioinguinal, iliohypogastric, and genitofemoral nerves as reported in cadaver studies.

Methods: We conducted a search in Pubmed, Embase, CNKI, and LILACS. Studies reporting on adult cadavers with detailed descriptions of the ilioinguinal, iliohypogastric, or genitofemoral nerves were included. Studies on cadavers that were previously operated on for inguinal hernia or anatomical areas not relevant to inguinal hernia surgery were excluded.

Results: Out of 2,196 records, 115 articles were screened, and 47 articles met the inclusion criteria. The ilioinguinal nerve was typically found in the Lichtenstein operative field, running ventrally along the spermatic cord, parallel to the inguinal ligament. The iliohypogastric nerve was usually located cranial to the ilioinguinal nerve and spermatic cord, positioned between the internal and external oblique abdominal muscles. The genitofemoral nerve was generally found beneath the spermatic cord alongside the accompanying vessels. While the iliohypogastric nerve displayed the most consistent anatomical position, all nerves showed significant variations, with frequent occurrences of nerve fusion.

Conclusion: The three major nerves involved in an open inguinal hernia repair exhibit considerable anatomic variability. Surgeons need to be cognizant of these variations to prevent nerve damage.