Minimally Invasive Open Preperitoneal Inguinal Hernia Repair

Abstract

Inguinal hernia is the most common form of hernia in adults, and is the result of either a congenital or acquired weakness in the lower abdominal wall, resulting in a defect through which the lining of the abdomen, or peritoneum, protrudes. An indirect inguinal hernia results from dilation of the internal ring over time, or a congenital patent processus vaginalis. In either case, a peritoneal sac herniates through the internal ring and often the external ring as well. In a direct inguinal hernia, transversalis fascia stretches out allowing for preperitoneal fat or peritoneal contents to herniate through Hasselbach’s triangle. This can result in swelling of the lower abdomen and, at times, pain. In severe cases, abdominal contents such as bowel can protrude through the weakness as well, creating a life-threatening condition. The aim of inguinal hernia surgery is to repair the structural integrity of the lower abdomen, and, in adults, placement of a mesh reduces the risk of reformation, or recurrence, of the hernia. The difficult recovery associated with traditional inguinal hernia repair, where the inguinal canal is opened, has driven interest in less invasive alternatives, such as laparoscopic and open preperitoneal approaches. In experienced hands, these latter approaches result in equivalent rates of recurrence with much improved postoperative recovery.