Adult inguinal hernia: pathophysiology and repair.
An anatomic and physiologic rationale is presented for the correction of inguinal hernias utilizing a simplified anterior approach, which opens and overlaps the transversalis-transversus abdominis posterior wall. The absence of tension is vital. It permits an uninterrupted repair of the direct and indirect components without additional reinforcement. A prospective randomized study is currently in progress comparing this two-layer technique to the author's three-layer modified Shouldice operation. Three-hundred and twenty-six repairs have been followed for at least 20 months with a mean follow-up time of 29 months. There have been two recurrences in each group. A better evaluation will be available when 1000 operations have been collected with a mean follow-up time of 46 months.
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012008:Recurrence; D013514:Surgical Procedures, Operative / Q000191:economics; D013530:Surgical Wound Infection / Q000517:prevention & control; D014945:Wound Healing