Summary
In the last 10 years, in Italy a rapid evolution has occurred from the “traditional” herniorraphies (Bassini, Shouldice) toward prosthetic techniques and outpatient procedures under local anesthesia are now most commonly preferred. Since october 1992 we have adopted a personal modification of the sutureless mesh repair, which we call held in mesh repair. Basic steps of this technique are: the placement of a plug in the deep ring for direct and indirect hernias; the linking of the medial edge of the prosthesis to the suture flattening the trasversalis fascia; the closure of the gap for the spermatic cord. With this technique 930 primary groin hernias were operated on in 798 patients (132 were bilateral); outpatient surgery was performed in 486 patients (60.9%). Anesthesia was local in 761 patients (95.4%). The mesh, generally sized 4.5×10 cm, in all cases was composed of polypropylene (Marlex® or Prolene®). 682 patients (85.5%) required analgesics. One hernia recurred (0.1%) after two years; one femoral pseudorelapse (0.1%) occurred at the 6th postoperative month. Nine complications occurred, for a rate of 0.9%. They were: one hemorrhage; 2 hematomas; one testicular atrophy; one lymphorrea; 2 ilioinguinal neuralgias; 2 seromas. No wound infections occurred; in none was it necessary to remove the mesh. The favorable results of the held in mesh repair and the simplicity of the procedure suggest that it can be considered a safe and reliable technique for most primary inguinal hernias. The negligible rates of femoral pseudorelapse and of indirect recurrences do not justify the employment in primary hernias of more complex preperitoneal techniques implying more complex anesthesia procedures and a higher C/B ratio.
Similar content being viewed by others
References
Amid PK, Shulman AG, Lichtenstein IL (1993) Critical scrutiny of the open “tensionfree” hernioplasty. Am J Surg 165:369–371
Arregui ME, Navarrete J, Davis CJ, Castro D, Nagan RF (1993) Laparoscopic inguinal herniorraphy: techniques and controversies. Surg Clin North Am 73:513–527
Corcione F, Cristinzio G, Cimmino V, Maresca M, Califano G (1995) La held in mesh per la terapia chirurgica ambulatoriale dell'ernia inguinale. Chirurgia 8:462–465
Fruchaud H (1956) Anatomie chirurgicale des hernies de l'aine. Doin, Paris
Gilbert AI (1991) Inguinal hernia repair; biomaterials and sutureless repair. Perspect Gentile Surg 2:113–129
Gilbert AI (1988) Sutureless repair of inguinal hernia. Am J Surg 163:331–335
Lichtenstein IL, Shulman AG, Amid PK, Montilor MM (1989) The tension-free hernioplasty. Am J Surg 157:188–193
Nyhus LM, Pollack R, Bombeck CT, Donahue PE (1988) The preperitoneal approach and prosthetic buttress repair for recurrent hernia. Ann Surg 208:733–737
Rives J (1967) Surgical treatment of the inguinal hernia with Dacron patch. Int Surg 47: 360–361
Stoppa R, Petit J, Abourachid H et al. (1973) Procédé original de plastie des hernies de l'aine: l'interposition sans fixation d'une prothèse en tulle de Dacron par voie médiane sous-péritonéale. Chirurgie 99:119–123
Trabucco EE (1989) Routine sutureless mesh in primary inguinal hernioplasty. Ann Coll Surg 13:541–544
Trabucco EE (1993) The office hernioplasty and the Trabucco repair. Ann Ital Chir 64:127–149
Wantz GE (1989) Giant prosthetic reinforcement of the visceral sac. Surg Gynecol Obstet 169:408–417
Wantz GE (1996) Experience with the tension-free hernioplasty for primary inguinal hernias in men. Journal of American College of Surgeons 183:351–356
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Corcione, F., Cristinzio, G., Maresca, M. et al. Primary inguinal hernia: The held-in mesh repair. Hernia 1, 37–40 (1997). https://doi.org/10.1007/BF02426387
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02426387