Adult Groin Hernia Repair: What’s New ?

The gold standard for groin hernia repair has changed with the new century. Today prosthetic repair is the best choice in adults, in accordance with the results of meta-analyses that demonstrated a 50% reduction of the recurrence rate, whatever the method, laparoscopic or open. As parietal prostheses marketing developed, the French National Health Service published a classification in 2008.Built on a better knowledge of interactions between the implanted prosthetic tissue and the human body, today the debate focuses on physical properties of the patch, which are mandatory to improve the patient comfort. Nature of the implanted material (mostly polypropylene or polyester) is no longer the main characteristic to notice. Physical properties of the implant, including strand size, weaving type, hydrophilicity and size of the pores should now be taken in consideration. Experimental works have established criteria of required solidity, elasticity, porosity, surface and weight for implants. They introduced the concept of Light Weight Mesh, with large pores and low density, to aim optimal control of the peri-prosthetic fibrotic process. Evolution of the prosthesis shape tends to facilitate procedures (pre-shaped, tailored, split, three-dimensional) and ergonomics (self-expansion, memory of shape, adhesiveness). New fixation systems, such as staples (absorbable or not), glue (biologic or synthetic) and self-retaining sutures complete this arsenal. The discussion between open or laparoscopic approach advocates is today modified with the development of new techniques of pre-peritoneal minimal invasive access (T.I.P.P., M.O.P.P). European Hernia Society guidelines recommend surgeons to be skilled in both techniques, so they are able to deal with all situations. Indications for the use of bio-prostheses in non-contaminated fields are not yet determined.