Open Repair - Herniorrhaphy
There are many tissue based methods for repairing the posterior wall of the inguinal canal but the chosen method depends on the area of muscle wall to be repaired and the surgeon's preference and include:
However these techniques are appropriate for smaller inguinal hernias and are rarely used due to the excellent results of the prosthetic (mesh) materials but in regions where access to prosthesis is compromised due to cost for example in developing countries or where there is a contamination risk, the Bassini, Shouldice and McVay techniques have continued to be the most effective. The Shouldice technique is also recommended where there has been contamination due to necrosis after bowel perforation to treat a strangulated inguinal hernia and has been found in to be the best non-mesh technique in terms of recurrence.
The Bassini technique involves suturing the transversalis fascia and the conjoined tendon to the inguinal ligament behind the spermatic cord and a J-shaped incision is made in the anterior rectus sheath to release the tension.
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The Shouldice technique is similar to the Bassini technique and involves an anatomical four-layered repair, seen in Figure 27 (Kingsnorth and LeBlanc, 2003), of the transversalis fascia, which includes the posterior wall, where the conjoint tendon is sutured to the inguinal ligament with non-absorbable sutures.
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The McVay technique involves the conjoined tendon, which is sutured to the inguinal ligament with interrupted non-absorbable sutures.
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