Properitoneal prosthetic inguinal hernioplasty through a Pfannenstiel approach

The recurrence rate after conventional inguinal hernia repair remains a matter of discussion and controversy. Reoperation for a postoperative recurrent hernia, especially when the defect is large, may be difficult if more than one operation has been performed. The idea of interposing a large surface of prosthetic mesh between the peritoneum and the deficient inguinal wall instead of "mending" the defect, represents a radical departure from previous methods of hernia repair. The mesh interposed between the properitoneal space and the musculofascial structures is the only obstacle to peritoneal and visceral protrusion. The mesh must be much larger than the defect, since it is not sutured in place and only intra-abdominal pressure maintains it in place over the hernia defect. This operation constitutes a prosthetic hernioplasty in contrast to the classic reparative herniorrhaphy. It can be carried out through an inguinal, midline or Pfannenstiel incision. During a period of 14 years, 767 patients underwent hernioplasty while 1,382 underwent conventional herniorrhaphy. The number and severity of septic complications was comparable in two groups--2 per cent. The reliability and efficiency of the technique described is demonstrated by the low recurrence rate after reoperation for recurrent hernia: only three (1.2 per cent) recurrences after 239 hernioplasty operations. Of the three techniques for hernioplasty, the "Pfannenstiel" appears to be the easiest, safest and most comfortable for the patient.