This represents the largest series of laparoscopic retroperitoneal triple neurectomies for treatment of inguinodynia. The rate of successful intervention was better than reported for standard triple neurectomy and open extended triple neurectomy. The procedure allows access proximal to all potential sites of peripheral neuropathy and overcomes many of the limitations of open triple neurectomy. In the absence of recurrence or meshoma, it is the preferred technique for definitive management of chronic inguinal neuralgia.

Inguinal hernia repair is one of the most commonly performed operations in the world, yet little is known about the genetic mechanisms that predispose individuals to develop inguinal hernias. We perform a genome-wide association analysis of surgically confirmed inguinal hernias in 72,805 subjects (5,295 cases and 67,510 controls) and confirm top associations in an independent cohort of 92,444 subjects with self-reported hernia repair surgeries (9,701 cases and 82,743 controls). We identify four novel inguinal hernia susceptibility loci in the regions of EFEMP1, WT1, EBF2 and ADAMTS6. Moreover, we observe expression of all four genes in mouse connective tissue and network analyses show an important role for two of these genes (EFEMP1 and WT1) in connective tissue maintenance/homoeostasis. Our findings provide insight into the aetiology of hernia development and highlight genetic pathways for studies of hernia development and its treatment.

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