Preperitoneal grid-iron hernia repair for hernia of the groin (Ugahary technique).

The objective of this new technique developed by F. Ugahary is totreat hernia of the groin by placing a large prosthesis for the unilateralreinforcement of the visceral sac in the preperitoneal space. It isa minimally invasive procedure, with a 3 to 4 cm grid-iron incision.It is inspired by the techniques of R. Stoppa and G.Wantz.Patients and methods: From 1995 to May 2003, F Ugahary, (Tiel,Netherlands) treated 1492 hernias (1374 patients); the rate of followup was 93%, with a mean follow-up time of 5 years. From March2001 to January 2004, 300 hernias (263 patients), were treated inCagnes sur Mer (Marc Soler, France). The mean follow-up timewas 18 months, the rate of follow up was 85%.Results: F. Ugahary : (n=1492). There was no postoperative death.There was one bladder injury, treated by the same incision. Eighteen(1.2%) postoperative complications occurred: in one case theprosthesis had to be removed, in three cases the resection or thedissection of the ilio-inguinal nerve was necessary, and in 13 casespunctures or evacuation of haematomas or seromas were necessary.One patient had persistent, severe pains after one year. The recurrencerate was 1.5% (22 cases). One incisional hernia was operatedon by muscular suture.M. Soler: (n= 300). There was no postoperative death. There were12 (4%) seromas or haematomas, necessitating two very simplelocal procedures. No severe chronic pain was observed. The recurrencerate was 2.3 % (7 cases).Conclusion: The F. Ugahary procedure combines the advantages ofthe posterior approach with those of minimally invasive surgery.Thus, a technically sophisticated procedure can be achievedwith minimum constraints for the patient, and probably at a minimalcost. The technique is suitable for a majority of groin hernias.The almost total absence of fixing of the prosthesis and the nearlyexclusive use of cleavable spaces probably contribute to the lowlevel of postoperative pain. With the results presented, a morewidespread diffusion of the technique seems legitimate.