[Reconstruction of the inguinal ligament in recurrent inguinal hernia using the "three-sheet" technique]

Destruction of the groin ligament is an unusual occurrence, often of traumatic or surgical origin. In the event of recurrent inguinal hernia with a destroyed inguinal ligament, the reconstruction of the wall with the surgical techniques currently available yields prognostically unfavourable results with frequent recurrence in only a short space of time. The aim of this report was to present a hernioplasty technique using the "three-sheet" implant involving reduction of the hernia sac and the affixing of two reinforcement nets in Prolene in an attempt to reconstruct the destroyed groin ligament. The three-sheet prosthesis simply consists of three sheets positioned in such a way (two polypropylene prosthesis are sutured one on top of the other perpendicularly and medially) as to form a new inguinal ligament; the first sheet reinforces the wall, reconstructing the posterior wall of the canal, and the second and third sheets support the peritoneum as in a hammock. From September 1995 to July 2006, 11 patients underwent such reconstruction operations in our division, 8 of them for recurrent inguinal hernia for multiple failure, 1 for an inguinal hernia with Cloquet's adenopathy and 2 secondary to femoro-femoral and iliac-femoral by-passes. To date, after a mean follow-up of 5 years, no recurrence has taken place. This method has proved safe and effective, with minimal risk of trauma and complications, and may therefore be indicated for the management of recurrent inguinal hernia with rupture of the inguinal ligament.