title: Proposed technique for inguinal hernia repair with self-gripping mesh: avoiding fixation to undesired structures.
abstract: OBJECTIVE
  Self-gripping meshes have been developed to avoid fixing sutures during inguinal hernia repair. Operative time is shorter when using a self-gripping mesh than with conventional Lichtenstein repair. However, these meshes can be difficult to handle because they fix to undesired structures. The aim of this report is to describe a new technique to avoid this problem.
  
  
  METHODS
  Inguinal hernia dissection is made as usual. Once dissection is finished, a Parietex ProGrip(®) (Covidien, Dublin, Ireland) flat sheet mesh is cut depending on the size needed. A small split is made between the lower and medium third of the mesh to mark where the split for the spermatic cord will be. Using this mark, the upper third of the mesh is folded over the medium third, hiding the microgrips that make this a self-gripping mesh. In this way, only the lower third of the mesh has the microgrips exposed and the mesh can be fixed to the pubic bone and inguinal ligament without fixation to undesired structures. Once the lower third of the mesh is fixed, the split for the spermatic cord is completed and the upper part of the mesh is passed below the spermatic cord. Then, the mesh is unfolded to expose the microgrips again and the medium and upper third of the mesh are descended to its final position.
  
  
  CONCLUSIONS
  This proposed technique for inguinal hernia repair with self-gripping mesh makes the surgery easier, avoiding mesh fixation to undesired structures.
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Santa Cristina, Calle Maestro Vives 2, 28009, Madrid, Spain.
authors.forename: J L
authors.initials: JL
authors.lastname: Porrero
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Santa Cristina, Calle Maestro Vives 2, 28009, Madrid, Spain. oscarcanovalderrama@hotmail.com.
authors.forename: O
authors.initials: O
authors.lastname: Cano-Valderrama
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Santa Cristina, Calle Maestro Vives 2, 28009, Madrid, Spain.
authors.forename: M J
authors.initials: MJ
authors.lastname: Castillo
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Santa Cristina, Calle Maestro Vives 2, 28009, Madrid, Spain.
authors.forename: M T
authors.initials: MT
authors.lastname: Alonso
mesh_terms: D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D013526:Surgical Mesh; D014014:Tissue Adhesives
chemical_list: D014014:Tissue Adhesives
keywords: Groin hernia; Inguinal hernia; Inguinal hernia repair; Parietex ProGrip®; Polyester mesh; Self-gripping mesh