The Marcy Repair Modified Using Cremaster Muscle Sparing. A New and Effective Method for Performing Prosthetic Hernioplasty

Abstract

The integrity of the internal inguinal ring (IIR) is essential to prevent the occurrence of indirect noncongenital inguinal hernia. Marcy first considered the importance of the IIR and proposed the use of annuloplasty to repair indirect primitive hernias. His procedure involved the resection of the cremaster muscle. We modified Marcy's annuloplasty by sparing the cremaster muscle and herein review our experience. We retrospectively reviewed a group of 213 male adult patients who were treated with annuloplasty of IIR for sliding or large indirect hernias, which was performed under local anesthesia as day cases. The median follow-up was 4.7 years (range 2-7 years). There were no complications due to annuloplasty and the overall recurrence rate at follow-up was zero. In our hernioplasty we prefer an anterior approach to avoid contamination with prosthetic materials of the zone under the transversalis fascia. The transversalis fascia remains an important anatomical barrier and the cremaster a natural diaphragm between the mesh and funicular structures. We believe that annuloplasty is effective in all types of hernias where a sliding or large indirect hernia is observed.