A "New" Nonmesh Technique for Inguinal Hernia Repair: Revisiting E. Wyllys Andrews and His Imbricating Operation

Abstract

The use of prosthetic mesh to repair inguinal hernias has been common practice at surgical centers around the world for more than 30 years. Open tissue repairs are the alternative for patients who cannot have, do not want, or are not offered mesh. Open tissue repairs are troubled by inferior recurrence rates in most clinical trials. In this article, we will review a long-forgotten tissue repair described by Andrews in 1895. In addition, we report on our early experience with the Andrews technique for primary inguinal hernia tissue repair.

FIGURE 1.

Edward Wyllys Andrews, MD, FACS, 1856–1927 (https://www.facs.org/about-acs/archives/past-highlights/andrewshighlight/)

FIGURE 2.

The imbricating hernia repair of Andrews. A, Segment of external oblique. B, Mattress deep stitches in posterior imbrication. C, Cord lifted. D, Lower flap of the external oblique. The (D) specifically shows suturing the external oblique to the free edge of the inguinal ligament over the spermatic cord (c1907 https://www.flickr.com/photos/internetarchivebookimages/14781986951)

FIGURE 3.

Bassini repair of the floor. Attachment of the conjoint tendon to the shelving edge of the inguinal ligament (original artwork by H Wang).

FIGURE 4.

Relaxing incision on the internal oblique fascia to reduce tension on the repair (original artwork by H Wang).

FIGURE 5.

Halsted-type repair of the inguinal floor, suturing the free edge of the external oblique fascia to the inguinal ligament under the cord (original artwork by H Wang).