[A direct approach and a crease-resistant prosthesis: two simplifications of subperitoneal hernioplasty]

With experience of six already known techniques, the authors have developed a personal procedure combining three main principles: 1) large and direct exposure of the preperitoneal space, 2) the mesh, supple but not soft, needing no fixation, 3) outline of this mesh adapted to the concave shape of the pelvic wall, and avoiding the risk of a ventral hernia. The original points of this technique are the following: approach along the lateral border of the rectus muscle through its sheath, the initial exposure of the iliopsoas muscle and retropubic space, and the cutting of the mesh extending far beyond the borders of the inguinal and femoral orifices, with a flap reinforcing the posterior aspect of the rectus muscle. One hundred and two consecutive patients (173 hernias, 48 recurrences) were operated upon, and all but two were followed for a mean period of 36.8 months. Morbidity was low, with no prosthesis infection, and there was no recurrence or incisional hernia. The authors emphasize the simplicity and the rapidity of this technique, without advocating it as a routine operation, since it carries, like all prosthetic techniques, the potential for sepsis and preperitoneal fibrosis.