Simplified preperitoneal marlex hernia repair

Abstract

The routine use of mesh for repair of inguinal hernia has been popularized by Lichtenstein and others. Although preperitoneal placement is more appealing than the onlay technique, the classical approach by Nyhus and Condon is difficult under local anesthesia and denervates the inguinal muscles to some degree. Preperitoneal mesh may become the standard for inguinal hernia as the laparoscopic approach becomes more popular. This report describes the author's first 100 hernia repairs done using a simplified preperitoneal approach under local anesthesia. The preperitoneal space is entered directly through the posterior floor, but a complete covering of the direct, indirect, and femoral spaces is accomplished similar to an open technique. After placement of the mesh, a truly "tension-free" closure of the posterior floor can be accomplished. Patients are discharged home in 1 to 2 hours. Because a standard approach and block are used, the learning curve for this operation should be brief compared with that of the laparoscopic method. The follow-up of this series is short (average: 15 months), but there have been no recurrences or infections. One patient returned to the operating room within 4 hours due to an arterial bleeder in Scarpa's fascia but was discharged that day and had no subsequent problems. Another patient has a postoperative neuralgia probably unrelated to the mesh. Otherwise, there has no complications with the placement of the Marlex mesh. Patients are allowed to return to full activity and work at their discretion.