Groin hernias. Preperitoneal repair by anterior approach. Operative technique

The technique of hernia repair described in this article consists inplacing the patch in the preperitoneal space (PPS) by anterior inguinalincision, under loco-regional or local anesthesia, so as to associatethe advantages of both methods. This technique is a simplificationof the Rives’ technique, which is feasible by the means of thePolysoftÒ patch (Bard-Davol, Cranston, RI, USA). The PolysoftÒpatch is made of a light polypropylene mesh, equipped with a thinand supple polyethylene memory-ring, providing memory of shape,so as to facilitate introducing and spreading of the patch in the PPS,through the hernia orifice.The hernia sac (direct or indirect) is dissected and reduced in thePPS. Blunt dissection is carried out through the hernia orifice in theplane of dissection located in close contact with the deep surface ofthe fascia, which is avascular. The patch is introduced through thehernia orifice and spread in the PPS. Minimal fixation is required.In this location the patch reinforces the fascia, restores the normalanatomic setting and oblique course of the spermatic cord. Thepatch is located in a deep anatomic plane, far from the ilio-inguinalnerve; this setting prevents contact between the patch and the nerve,which can induce chronic pain due to irritation of the nerve.