During laparoscopic hernia repair, which nerve is most at risk for injury?

The ilioinguinal nerve is most at risk for injury during laparoscopic hernia repair. This nerve primarily supplies sensation to the skin of the groin and the upper medial thigh, and it runs in close proximity to the inguinal region where hernias are commonly repaired.

During laparoscopic procedures, particularly hernia repairs, the surgeon makes abdominal entry points that may involve displacing or manipulating tissue in areas where the ilioinguinal nerve passes. Injury to this nerve can lead to complications such as pain, numbness, or dysesthesia in its sensory distribution area.

While other nerves mentioned may also be important, their anatomical locations and pathways make them less susceptible to injury during this specific surgical procedure. The medial femoral nerve of the thigh and the lateral femoral nerve of the thigh are located more distally and are generally safeguarded due to their positions relative to typical surgical access sites. The genitofemoral nerve, while relevant, is also less likely to be directly impacted during a laparoscopic hernia repair compared to the ilioinguinal nerve. Thus, understanding the anatomy and the proximity of these nerves during surgery is crucial for minimizing the risk of nerve injury.