A 58-year-old man undergoes open tension-free mesh repair for a right direct inguinal hernia. During dissection of the spermatic cord, the surgeon identifies three structures within the cord. Which of the following is NOT a true component of the spermatic cord?

Explanation

## Components of the Spermatic Cord The spermatic cord is a composite structure containing multiple elements that must be carefully preserved during hernia repair to avoid complications such as testicular atrophy, chronic pain, or infertility. ### True Components of the Spermatic Cord (3 arteries, 3 fasciae, 3 nerves): **Arteries:** - Testicular artery (from abdominal aorta) - Artery to vas deferens (from inferior vesical artery) - Cremasteric artery (from inferior epigastric artery) **Veins:** - Pampiniform plexus (drains to testicular vein) **Nerves:** - Sympathetic fibers - Parasympathetic fibers - Ilioinguinal nerve (runs alongside the cord in the inguinal canal) **Fasciae:** - External spermatic fascia (from external oblique) - Cremasteric fascia (from internal oblique) - Internal spermatic fascia (from transversalis fascia) **Key Point:** The genital branch of the genitofemoral nerve is NOT a component of the spermatic cord. It runs alongside the cord in the inguinal canal but is a separate structure. The ilioinguinal nerve (not genitofemoral) is the nerve that runs with the cord and must be identified and preserved. **High-Yield:** Injury to the ilioinguinal nerve during hernia repair causes chronic groin pain and numbness. The genital branch of genitofemoral nerve supplies the cremaster reflex and scrotum but does not run within the cord itself.