Functional preperitoneal mesh repair of inguinoscrotal indirect hernia through inguinal approach

Abstract EN

This study included 43 male patients with 45 inguinoscrotal indirect inguinal hernias, admitted in the surgery department — Assiut university Hospital in the period between January, 1999 to January, 2002, their ages ranged from 33 to 69 years with mean age 48.1.

The hernias were right in 24 patients, left in 17 patients and bilateral in 2 patients (4 operations).

In 8 patients the hernias were recurrent.

In bilateral cases, the operations were done sequentially with 2 months in between the two.

All the primary hernias were classified as Nyhus type III (posterior wall defect) and the recurrent ones were Nyhus type IV.

Through an inguinal approach, Prolene mesh, 6 x 11 cm2 in diameters, was placed in the preperitoneal space of Bogros deep to the inferior epigastric vessels after opening of the 2 layers of the transversalis fascia.

Parietalization of the cord structures was done in 23 settings and slit opening of the mesh laterally to accommodate the cord was done in 22 settings.

The prosthesis was fixed by prolene suture No (0) to the pubic tubercle, Cooper's ligament and femoral fascia inferior ly, to the back of the conjoint area medially and internal oblique and transversus muscles superiorly.

After closure of the transversalis fascia, loose Bassini type of repair was done.

In all patients, prophylactic antibiotic, Zinnat 1.5 g intravenously was usedfor 3 days.

After a mean period offollow up of 90.7% ofpatients for 14-27 months (mean = 21.6m), no incidence of infection or recurrence was recorded.

We conclude that, preperitoneal mesh repair of inguino-scrotal hernia through inguinal approach has very satisfactory results and is indicated when the posterior inguinal wall is weak so that repair of hernia without mesh makes it liable for recurrence.