A new method of hernioplasty for adult groin hernias centering on repair of the transversalis fascia

We compared a new fascia transversalis based hernioplasty with mesh repair techniques which leave the fascia transversalis intact. We prospectively randomized 180 consecutive patients with inguinal hernia to undergo one of the three hernia repair techniques. Hernias were repaired either by using the new fascia transversalis repair-Coskun's hernia repair (FTR), based on the plication of fascia using continuous sutures and followed by a second layer of interrupted or continuous sutures between inguinal ligament and conjoint tendon to distribute the tension, or one of the two mesh repair techniques: anterior (Lichtenstein) or posterior (preperitoneal) repair. Parameters such as age, sex, hernia cause, operation time, type of anesthesia, surgeon's seniority, complications, hospital stay and follow-up were evaluated. Recurrence rates were determined through clinical examination. Effect of prostatism, co-morbid disease, operation time, complications and Nyhus type of hernia on recurrences were also analysed. Most patients in each group were operated on under general anesthesia (78% vs. 80% vs. 85% for FTR, Lichtenstein, and preperitoneal repair, respectively) and by surgeons in training (average 78%). Patients were followed up for a median of 36 months. FTR had less complications and an acceptable time for operation whereas preperitoneal repairs needed more seniority, longer operation time, and caused more complications. There were only 3 (1.6%) recurrences, none in the FTR group and two the in Lichtenstein group during first postoperative year. There was no recurrence in preperitoneal repair group. All patients with recurrences had an operation time longer than 60 min and were operated on by surgeons in training. Two patients with recurrences had prostatism symptoms and chronic cough. We conclude that the new FTR is as effective as mesh repair (either anterior or posterior) with an acceptable rate of recurrences, fewer complications, and that it can be performed by the surgeons in training.

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New technique for inguinal hernia repair

Çoşkun

Özmen

Moran

et al. 2004

Hernia

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Anatomical observations on 30 cadavers: new insights into the relationship between the posterior wall of the inguinal canal and the cremaster

Xiao,

Zhou,

Yan

et al. 2024

BMC Surg

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Purpose Clarify the composition of the Posterior wall of the Inguinal Canal(PWIC), the location and composition of the Transverse Fascia(TF), and the tissue origin of the Cremaster(C) by observing the anatomy of the inguinal region of the cadaver. Methods 30 cadavers were dissected to observe the alignment of the muscles and fascia of the inguinal canal and the anterior peritoneal space. the anatomical levels of the posterior wall of the inguinal canal and the alignment of the Spermatic Cord(SC) were observed. Results (1) The posterior wall of the inguinal canal was white, bright, and tough tendon membrane-like tissue; (2) the transverse fascia was a thin fascial tissue with only one layer of membranous structure located in the abdominal wall under the abdominal wall on the side of the blood vessels of the peritoneal cavity; (3) the internal oblique muscle and its tendon membrane, and the transversus abdominis muscle and its tendon membrane extended on the surface of the spermatic cord, and fused and continued to the cremaster on the surface of the spermatic cord. Conclusions 1. PWIC is mainly composed of Internal oblique muscle of abdomen (IOMA), Aponeurosis of internal oblique muscle of abdomen (AIOMA), Transverse abdominal muscle (TAM), and Transverse abdominal aponeurosis(TAA) as the following four types: (1) TAM and AIOMA fused to form a tendinous layer; (2) IOMA and TAM form the posterior wall of the muscle in the PWIC; (3) IOMA and AIOMA continue in the PWIC; 4) TAM and TAA continue in the PWIC. 2.TF is a thin fascial tissue with only one layer of membrane structure, TF is not involved in the composition of PWIC, so this fascia has nothing to do with resisting the occurrence of inguinal hernia. 3. The spermatic cord that travels in the inguinal canal is fixed to the lower wall of the inguinal canal by the tendon membrane of the cremaster, which is organized from the internal oblique and transversus abdominis muscles and their tendon membranes, The inguinal canal is a musculotendinous canal.

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A new method of hernioplasty for adult groin hernias centering on repair of the transversalis fascia

Cited by 2 publications

References 5 publications

New technique for inguinal hernia repair

New technique for inguinal hernia repair

Anatomical observations on 30 cadavers: new insights into the relationship between the posterior wall of the inguinal canal and the cremaster

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