Sutureless repair of inguinal hernia

doi:10.1016/0002-9610(92)90015-J

The American Journal of Surgery

Volume 163, Issue 3, March 1992, Pages 331-335

https://doi.org/10.1016/0002-9610(92)90015-J Get rights and content

Abstract

Sutureless repair is successful for all but the largest of indirect inguinal hernias. After reduction of the peritoneal sac, the presenting indirect component of the hernia is immediately resolved by placement of a polypropylene mesh through the internal ring. The posterior wall is reinforced with a second swatch of Prolene mesh to prevent herniation, which often results from future degenerative changes. Both swatches of mesh are held in place in separate tissue planes by the body's internal hydrostatic forces. Being sutureless, no tension is placed on any layer, there is no damage to tissues from an errant suturing technique. This procedure has been used in 412 of the 1,091 inguinal hernia repairs over the past 36 months.

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There are more references available in the full text version of this article.

Cited by (146)

Fixation free femoral hernia repair with a 3D dynamic responsive implant. A case series report
2018, International Journal of Surgery
Citation Excerpt :
Lichtenstein first introduced a cylindrical shaped polypropylene mesh into the femoral ring to repair femoral hernias [18]. Gilbert, intraoperatively, rolled out a conic shaped piece of polypropylene with the intent to obliterate the femoral defect [19]. In the late 90s, Rutkow and Robbins developed a pre-shaped mesh plug to repair inguinal and femoral hernias [20].
To date, no gold standard for the surgical treatment of femoral hernia exists. Pure tissue repair as well as mesh/plug implantation, open or laparoscopic, are the most performed methods. Nevertheless, all these techniques need sutures or mesh fixation. This implies the risk of damaging sensitive structures of the femoral area, along with complications related to tissue tear and postoperative discomfort consequent to poor quality mesh incorporation. The present retrospective multicenter case series highlights the results of femoral hernia repair procedures performed with a 3D dynamic responsive implant in a cohort of 32 patients during a mean follow up of 27 months.
Aiming to simplify the surgical procedure and reduce complications, a 3D dynamic responsive implant was delivered for femoral hernia repair, in a patient cohort. After returning the hernia sack to the abdominal cavity, the implant was simply delivered into the hernia defect where it remained, thanks to its inherent centrifugal expansion, obliterating the hernia opening without need of fixation. Postoperative pain assessment was determined using the VAS score system.
The use of the 3D prosthetic device allowed for easier and faster surgical repair in a fixation free fashion. None of the typical fixation related complications occurred in the examined patients. Postoperative pain assessment with VAS score showed a very low level of pain, allowing the return of patients to normal activities in extremely reduced times. In the late postoperative period, no discomfort or chronic pain was reported.
Femoral hernia repair with the 3D dynamic revealed a quick and safe placement procedure. The reduced pain intensity, as well as the absence of adverse events consequent to sutures or mesh fixation, seems to be a significant benefit of the motile compliance of the device. Furthermore, this 3D prosthesis has already proven to induce an enhanced probiotic response showing ingrowth in the implant of the typical tissue components of the abdominal wall, instead of the low quality tissue ingrowth typical in conventional meshes and plugs. The highlighted features seem to represent a more physiologic and updated repair concept of femoral protrusions.
Invasiveness of surgical procedures for inguinal hernia repair
2016, Revista Hispanoamericana de Hernia
La evolución histórica de las técnicas hernioplásticas inguinales se ha caracterizado, entre otros motivos, por la progresiva reducción de la agresividad de los abordajes. Estos pueden ser invasivos, miniinvasivos y mínimamente invasivos, según la dimensión de la incisión. Con frecuencia, por una confusión perceptivo-conceptual, la agresividad incisional se confunde con la generada por la disección tisular de la ingle, extendiendo y entendiendo el concepto de miniagresividad del abordaje al producido por el traumatismo global de la técnica (el incisional más el disectivo), lo que constituye un error, más patente en determinadas técnicas (desde el abordaje extenso en la técnica de Stoppa a los mínimos en las técnicas videoscópicas, conceptuadas como técnicas mínimamente invasivas y muy poco agresivas, cuando el campo quirúrgico es objetivamente demostrativo de una extensa disección agresiva).
Para evaluar las variaciones del traumatismo global que generan las técnicas quirúrgicas de las hernias, se aporta una clasificación original de las técnicas hernioplásticas con arreglo a la dimensión (cuantitativa) de la incisión (maxi-, normo- o miniinvasiva), y la extensión (cualitativa) de la disección tisular (mini-, normo- o maxidisectiva).
Con ella es posible tipificar cada técnica en el grupo correspondiente, de manera que a través de los tipos y grupos de técnicas en la clasificación el cirujano puede conocer con una aproximación objetiva y real el daño tisular global generado por cada técnica y, simultáneamente, disponer de una información añadida que le facilite en este sentido la decisión para elegir el tipo de hernioplastia que considere más apropiado.
Developments in inguinal hernioplasty techniques have sought, among other factors, to reduce the aggressiveness of the surgical approach. Thus, access may be invasive, miniinvasive or minimally invasive according to incision size. However, the concept of surgical aggression is often erroneously interpreted as the insult produced by the route of tissue access without considering the impact of the tissue dissection produced in the groin area. This misleading interpretation has been more obvious for some techniques ranging from the extensive approach of the Stoppa technique to the minimal approaches of today's videoscopic techniques. Thus, these videoscopic techniques have been interpreted and described as minimally invasive and scarcely aggressive while there is little argument that the surgical field they create is one of extensive aggressive tissue dissection.
To assess the general surgical insult produced by a hernia repair technique, this study proposes the classification of these techniques according both to the size (quantitative) of the surgical access incision (as maxi-, normo- or miniinvasive), and the extension (qualitative) of tissue dissection produced (as mini-, normo- or maxidissective).
Using this system, each technique can be classified so that the surgeon will have a real objective idea of the overall tissue damage a given procedure will induce. This additional information will help in choosing the most appropriate hernioplasty method in each case.
Femoral Hernia
2012, Shackelford's Surgery of the Alimentary Tract: Volume 1-2, Seventh Edition
Basic Features of Groin Hernia and Its Repair
2012, Shackelford's Surgery of the Alimentary Tract: Volume 1-2, Seventh Edition
Surgical Progress in Inguinal and Ventral Incisional Hernia Repair
2008, Surgical Clinics of North America
Citation Excerpt :
The concept of plugging the inguinal canal with foreign material and tissue to repair defects began in the mid-nineteenth century (Fig. 1). In 1987, Gilbert refined the mesh plug technique into the cone or umbrella shape, which Rutkow and Robbins developed into the preformed cone that is now commercially available [10–12]. A recent randomized controlled trial found the mesh plug and Lichtenstein repair to have comparable recurrence rates [13].
Comparative Study between Lichtenstein versus Lichtenstein Combined with Mesh Plug in Management of Inguinal Hernia
2022, International Journal of Medical Arts

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Sutureless repair of inguinal hernia

Abstract

Am J Surg

Surg Clin North Am

Lancet

Surg Clin North Am

Surg Clin North Am

Recurrent inguinal hernia

Surg Clin North Am

Internal inguinal ring

Br J Surg

A method of herniotomy utilizing only white fascia

Ann Surg