[Surgical physiopathology of the inguinal region].
Bassini's procedure is based on the pivotal role played by the transversalis fascia in inguinal containment. The other important constituent of inguinal reinforcement is the flax inguinalis, which forms the curved upper edge of the "inguinal hiatus", whose base is formed by the inguinal ligament. This hiatus closes or contracts when the intra-abdominal pressure increases. It is clear that if the muscles are strong this action will be effective in containing the wall. By contrast, the more relaxed the inguinal cleft is, the more ineffective this action may become. Weakness of the muscular-aponeurotic structure thus becomes all the more important. Two systems are therefore available to contain the inguinal hiatus: the transversalis fascia and the falx inguinalis. Under normal conditions, they act synergistically to contain the wall. The relevance of the function of each, however, is debatable. With Bassini's repair, containment is assured if the transversalis fascia is used, i.e., if a true "triple layer" operation is performed. Procedures such as Lichtenstein's do not act upon the transversalis fascia: if this is weak or perforated, abdominal pressure weighs on the prosthesis. Moreover, a mesh that is not well attached may lead to recurrence. The crucial role of the transversalis fascia is proved by procedures with preperitoneal mesh prostheses. In these procedures, performed with videolaparoscopic techniques or according to Stoppa's or Rives' methods, or even with an inguinal preperitoneal mesh (as in a series of ours treated with positive results), the repair involves only the transversalis fascia. These repair procedures confirm the superiority of the transversalis fascia procedure in assuring inguinal containment.
Mattioli
Francescopaolo
F
Clinica Chirurgica R, Dipartimento Discipline Chirurgiche, Morfologiche e Metodologie Integrate (DICMI), Università degli Studi di Genova.
D006119:Groin; D006552:Hernia, Inguinal / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007264:Inguinal Canal / Q000503:physiopathology; D019736:Prostheses and Implants; D013526:Surgical Mesh