Surgical Techniques for Inguinal Hernia Repair: Open Tension-Free Repairs

Abstract

Tension-free repair (TFR) is hernioplasty using prosthetic mesh or device to replace or reinforce abdominal wall defect, without forceful pull between tissues or tissue-prosthesis junction with sutures. Open tension-free repair (TFR) is the most common groin hernia repair, representing 70% of all hernia repairs performed in the developed countries (Lomanto et al., Asian J Endosc Surg 8:16–23, 2015), the procedure is easy to learn, quick to perform, safe and cost-effective, and can be done without general anesthesia (Awad and Fagan, Am J Surg 188:9S–16S, 2004). With triple-triangles of the myopectineal orifice treated as a whole, the prosthetic mesh material could replace or reinforce the attenuated abdominal fascia and muscles without tension, resulting in minimized postoperative pain and recurrences (Jacobs, N Engl J Med 350:1895–7, 2004). The 2009 and 2014 European Hernia Society guidelines also recommend open TFR (Lichtenstein, Plug and Patch, Prolene Hernia System) and endoscopic repair as the choices for unilateral primary groin hernia for adult patients (Simons et al., Hernia 13:343–403, 2009; Miserez et al., Hernia 18:151–63, 2014).