The course of the iliohypogastric and ilioinguinal nerves in the anterior abdominal wall and their relationship to the appendectomy incisions

Abstract

Incisions for appendectomy and other abdominal operations can cause injuries to the iliohypogastric and ilioinguinal nerves and inactivation of the shutter mechanism so that, these surgical procedures may be an etiologic factor in the developement of inguinal hernia. In this study, we aimed to research the effect of appendectomy incisions on the development of inguinal hernias by performing ilioinguinal and iliohypogastric nerves dissections. We studied the course of the iliohypogastric and ilioinguinal nerves in a total 12 formalin fixed cadavers (11 male, 1 female). In addition we reviewed 242 patients who were operated on for inguinal hernia between 1993- 1996 in Ankara University Faculty of Medicine Department of General Surgery. 21 of these previously underwent appendectomy. We concluded that iliohypogastric nerve might be dissected during Me Burney or Elliot insicions in 17.3 % of these cases, but the ilioinguinal nerve was not dissected. However, iliohypogastric and ilioinguinal nerve were dissected in all cases with paramedian incisions. We supported these results by the cadaver findings anatomically and concluded that the type of insicion for appendectomy is closely related to the development of inguinal hernias. We did not find any other study which the results were supported by demonstrating in cadavers dissections in the literature.