Primary inguinal hernia: The held-in mesh repair

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.