It Would Be Nice everyone’s body was exactly the same on the inside. That way it a surgeon would always know where important structures were located and therefore during surgery, these vital structures could be quickly identified and protected. But the human body makes its own decisions and does not always follow the rules found in the anatomy books.

During hernia repairs, the nerves are the structure most commonly in the “wrong place”.
In the anatomy books, the genital nerve usually is on the posterior aspect of the cord, but it can be found on the floor of the inguinal canal or along the inguinal ligament. The Ilioinguinal nerve usually runs on the anterior aspect of the spermatic cord, but it can run along the internal oblique muscle. The iliohypogastric nerve usually runs along the anterior aspect of the internal oblique muscle, but it can be found traveling within the fibers of the internal oblique and sometimes superficial to the external oblique muscle.

Because the location of the nerves is highly variable they are one of the most common structures damaged during surgery.

Please have your operation done carefully and by a surgeon who knows the anatomy and the possible variations.

Take a look at the two photographs below.  The first photograph shows a patient with two iliohypogastric nerves instead of the usual one. The second photograph shows a patient with a large common nerve that then splits into the iliohypogastric nerve and the ilioinguinal nerve.

Bill Brown, MD



Dr. Brown has been performing sports hernia surgeries using non-mesh techniques since 1999. As one of the top no-mesh hernia repair surgeons in the U.S., he is an expert on the subject and will be happy to answer any questions or concerns regarding hernia repair with mesh.