A New Open Minimal Access Approach for Mesh Repair of Inguinal Hernia

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Mesh repair of inguinal hernia by open surgery is traditionally done with an oblique inguinal incision of 4-5 cm and by opening the inguinal canal by incising external oblique aponeurosis. We are presenting a new technique for mesh repair of inguinal hernia with two mini incisions, one over the superficial, and another over deep inguinal ring and without incising the external oblique aponeurosis. Methods: The study group comprised of 104 males patients undergoing surgery for inguinal hernia during the period January 2010- January 2015. Data regarding patient demographics, type of anesthesia given, operation performed, and complications were recorded. The operation was carried out under spinal or epidural anesthesia. With a transverse incision of size 1-1.5 cm at the superficial inguinal ring, the cord structures were reached and lifted up with the finger,. By passing an artery forceps with the tip upwards under neath the external oblique aponeurosis, another incision of 1-1.5cm was made at the deep inguinal ring and the cord was lifted up by mobilizing. The indirect sac was dissected, ligated and mesh was sutured to the inguinal ligament by interrupted sutures and on the other side to conjoined tendon by retracting wound. The patients were followed up in the post-operative period. Results: There were 104 men with an age range of 20-64 years (mean35.6). On examination, 84 patients had indirect inguinal hernia and 20 patients had direct hernia. The incision size at superficial ring and deep rings measured at the end of the operation was1.4cm, (range1.2 -2cm).Through the incision at the deep inguinal ring, the indirect sac could be identified, transfixation, ligation and excision of sac was done without difficulty. The mesh could be easily passed underneath the external oblique, spread and sutured. 3- sutures could be applied by retracting the external oblique. No drain was required in any repair. The mean operation rime was 54 minutes (range50-62 minutes).There was no post-operative hematoma or scrotal edema in any of the patients.. During a mean follow-up period of 48 months (range 12-60 months,), there was no recurrence and one patient had chronic pain. Conclusion: Inguinal hernia mesh repair with two mini incisions, one over the superficial inguinal ring and one over the deep inguinal ring and without incising the external oblique aponeurosis gives adequate exposure to place the mesh and repair the hernia. Follow- up did not show any recurrence or or significant chronic pain.