Purpose <p>Injury to inguinal nerves remains a leading cause of chronic postoperative pain following anterior inguinal hernia repair. This study aimed to evaluate the feasibility and safety of intraoperative neural autofluorescence using near-ultraviolet (NUV) imaging for real time identification of target nerves during open Lichtenstein hernioplasty and to assess its potential to reduce neuropathic complications.</p> Methods <p>Five male patients with primary inguinal hernias and varying clinical profiles underwent open hernia repair with the adjunct use of NUV autofluorescence to enhance intraoperative nerve mapping. Operative time, intraoperative nerve visualization, and early postoperative outcomes were recorded. Patients were followed for sensory deficits, functional limitations, and chronic pain over 12 months.</p> Results <p>Neural autofluorescence enabled consistent and unambiguous identification of the ilioinguinal, iliohypogastric and genitofemoral nerves-including both genital and femoral branches-in all cases. The additional time required for nerve mapping was negligible. No intraoperative complications, postoperative morbidities, or readmissions were reported. At one-year follow-up, all patients were free from chronic groin pain, sensory compromise, or functional limitations.</p> Conclusions <p>Intraoperative neural autofluorescence is a safe and technically feasible adjunct during open Lichtenstein repair, allowing for reliable nerve identification without altering surgical workflow. These preliminary findings suggest a potential role in reducing the risk of iatrogenic nerve injury and postoperative neuropathic pain. Further evaluation in larger, controlled studies is warranted to define its value in routine hernia surgery.</p>