Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2006 Sep;2(3):134-8.
doi: 10.4103/0972-9941.27725.

Cure of inguinal hernias with large preperitoneal prosthesis: Experience of 2,312 cases

J H Alexandre  1 , J L Bouillot, P Dupin, K Aouad, J P Bethoux
Affiliations

Cure of inguinal hernias with large preperitoneal prosthesis: Experience of 2,312 cases

J H Alexandre et al. J Minim Access Surg. 2006 Sep.

Abstract

It is clear that the recurrence rates after nonprosthetic methods for the repair of inguinal hernias, like McVay, Bassini or Shouldice techniques, are high (6-10%). Since 20 years, we are convinced, in the GREPA-EHS group, about the advantages of the use of a prosthetic mesh in majority of patients for repairs of primary or recurrent inguinal hernias and incisional hernias. We describe our typical technique for the cure of all inguinal hernias. We place a large supple mesh, by open inguinal route, posterior to the transversalis fascia and anterior to the peritoneum. We have made a double modification in the initial technique of Rives - the use of a very large unsplit prosthesis (15 × 17 cm) and the parietalization of the spermatic cord helped by a wide opening of the Fruchaud's orifice by diversion of the epigastric vessels. The positioning of the mesh is about the same as in the TEP technique but with the advantages of reduction in the vital laparoscopic risks and reinforcement of the wall by a short tension-free McVay technique.For this prospective study, we repaired 2,312 consecutive hernias in 1,828 patients, 284 of which were recurrent. We present our results in terms of quality of repairs, recurrence rates (0.4%), morbidity rate (8%), and mortality rate (0.8%).This technique involves the placement by an open incisional route of a large preperitoneal sheet of mesh for initial treatment of all inguinal hernias - including scrotal, giant or femoral - to ensure a definitive solid muscular wall, even for recurrent hernias.

Keywords: Femoral hernias; giant hernias; inguinal hernias; preperitoneal mesh; recurrent hernias.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Exposure of the area after section on the fascia transversalis, division of epigastric vessels and displacement of the cord
Figure 2
Figure 2
Position of the mesh over the peritoneum and above the parietalized spermatic cord
Figure 3
Figure 3
Dissection of the sac: nonabsorbable sutures passed through Cooper's ligament
Figure 4
Figure 4
Closure of the wall over the prosthesis
See this image and copyright information in PMC

References

    1. Debord JR. Prostheses in hernia surgery: A century of evolution. In: Bendavid R, editor. Abdominal wall hernias. New York: Springer; pp. 16–32.
    1. Alexandre JH, Dupin P, Levard H, Billebaud T. Treatment of inguinal hernia with unsplit mersylene prosthesis. Significance of the parietalization of the spermatic cord and the ligation of epigastric vessels. Presse Med. 1984;13:161–3. - PubMed
    1. Read RC. The preperitoneal approach to the groin and the inferior epigastric vessels. Hernia. 2005;9:79–83. - PubMed
    1. Grant AM. EU Hernia Trialists Collaboration. Laparoscopic versus open groin hernia repair. Meta analysis of randomized trials based on individual patients data. Hernia. 2002;6:2–10. - PubMed
    1. Lichtenstein IL, Shulman AG, Amid PK. Use of mesh to prevent recurrence of hernia. Postgrad Med. 1990;87:155–60. - PubMed