The surgical approach for neurectomy is still a controversial issue. The traditional anterior approach to the ilioinguinal and iliohypogastric nerves [
9], has been reported to have success rates between 30 and 100% [
10,
11]. Surgery as an option for treating nerve-associated pain was described by Stulz and Pfeiffer, in 1982 [
12]. Cicatricotomy to treat inguinal neuralgia after inguinal herniotomy, appendicectomy, and gynecological operations, was performed by them. Surgical neurectomy is the optimum method of treatment when conservative treatment has failed, and it was postulated that ilioinguinal nerve is the most endangered after hernia surgeries [
5,
10,
11,
13]. This shows that our case is even rarer due to the involvement of iliohypogastric nerve. Moreover, Vuilleumier used an open approach to perform a radical ilioinguinal nerve and iliohypogastric nerve neurectomy without routinely dissecting the genitofemoral nerve, having 95% pain relief in 49 patients [
11]. Some authors found beneficial results resecting only the specific nerves that fit the clinical pain syndrome- ‘tailored neurectomy’ [
13]. In addition, the use of cross-sectional computed tomography (CT) has been advocated to exclude recurrence or meshoma and investigate other differential diagnoses of chronic postoperative inguinal pain [
14]. This explains the use of CT scan as imaging modality in our case.
Up to now there has been no specific guidelines about the treatment of this clinical entity and surgical neurectomy has proved to be the most effective treatment modality.
We, therefore, reported this case to increase awareness among clinicians and stress on the importance of the identification of iliohypogastric nerve in open hernioplasty. However, our limitation is that it is a single case experience and conclusion can only be drawn based on our experience.