Although uncommon, neuralgia and paresthesia secondary to perineural fibrosis or actual nerve injury following inguinal hernia repair may result in severe long-term morbidity. The most common cause of intra-operative nerve injury is unfamiliarity with normal variations of ilioinguinal and iliohypogastric nerves. The two main types of nerve injuries are transaction injuries and those resulting in lesion incontinuity.
Dysfunction resulting from neurapraxis is transient.
Neuronotomesis however leads to neuroma requiring operative intervention. The fact that the onset of pain is triggered or at least aggravated by walking or hyperextension of hip and helped by recumbency and flexion of the thigh, suggests that traction of the nerve plays a major role. The ilioinguinal nerve should be looked for lateral to the internal ring. This is relatively easy because this area is usually un-touched during the original operation. The iliohypogastric nerve is visualized by separation of the external oblique from the internal oblique muscle and aponeurosis.