Preperitoneal Open Repair of Groin Hernias Using Prosthetic Reinforcement

Abstract

Open preperitoneal mesh repairs of groin hernias place non-absorbable mesh through an abdominal incision in a plane outside the peritoneal cavity, between the peritoneum and the anterior abdominal wall. The ‘classical’ preperitoneal repairs were developed just prior to the laparoscopic era as a way of dealing with difficult recurrent groin hernias with extensive scarring and tissue loss. Newer open preperitoneal techniques are being advocated for primary inguinal hernia repair, devised in the expectation of reducing the incidence of long-term post-operative discomfort that is possibly related to the presence of mesh in the inguinal canal. This chapter reviews the history and development of the classical approach and describes the newer small incision techniques with their reported results. While it remains to be seen whether or not these newer methods prove their usefulness in everyday general surgical practice, the classical operations remain a useful technique even in the laparoscopic era and should have a place in the toolkit of every surgeon who declares an interest in hernia surgery.