Inguinal hernia repair with the peduncled fascial flap: a new surgical technique

This paper presents a new surgical technique of inguinal hernia repair in which both crura of the aponeurosis of the external oblique abdominal muscle and transverse fascia were used for complex reconstruction of the entire musculopectineal hiatus.

Between 2nd December 2003 and 29th April 2005, 250 patients (233 male and 17 female) underwent inguinal hernia repairs using our own technique. The inguinal canal was opened together with the posterior wall, dividing the transverse fascia into two flaps. The lower flap was inserted into the femoral opening and sewn to the pectineal ligament, whereas the upper flap with both crura of the aponeurosis of the external oblique abdominal muscle were used for three-fascia reconstruction of the posterior wall of the inguinal canal. The study group was randomly chosen from patients undergoing surgery due to inguinal hernias in our hospital. Procedures were carried out under subarachnoid anaesthesia; postoperative pain was treated with methamizol or ketoprofen. Patients were discharged 48 h after surgery.

The postoperative complications included one hernia recurrence and one testicular atrophy. The remaining complications were transient and included prolonged wound healing, transient skin hypoaesthesia around the wound or testis oedema.

The technique used strengthens the musculopectineal hiatus, effectively preventing recurrences of inguinal as well as femoral hernias.