Some problems encountered at re-operation following repair of groin hernias with pre-peritoneal prostheses

Summary

The easy performance and efficiency of these repairs is nonetheless accompanied by some drawbacks of which the surgeon should be aware. These may be discovered when reoperating on the bladder, prostate or iliac vessels. The difficulties are related to the extensive fibrosis involving the cave of Retzius and/or the space of Bogros. The authors report their intraoperative and anatomical findings. They propose the following solutions: 1. When cleavage of the cave of Retzius is impossible (in bladder or prostate surgery): a retropubic subperiosteal plane is developed, either isolated or combined with a transperitoneal approach. 2. When cleavage of the space of Bogros is impossible (in surgery on the iliac vessels): a transperitoneal approach is used. Prevention of fibrosis after the use of large prostheses can be achieved by preservation of the funicular sheath which protects the iliac vessels, providing no slit has been made in the mesh and by preservation of the umbilico-prevesical fascia.