The management of recurrent inguinal hernias by muscle transposition--a preliminary communication

Recurrent inguinal hernias occur almost exclusively in adult men. The rarity of both direct and recurrent hernias in women is due, among other factors, to the muscularity of an inguinal canal that has not been partially replaced by fibrous tissue to allow the passage of a large spermatic cord. Throughout the body, contractile dynamic muscular tissue resists strains and stresses better than do fascia and ligaments. With regard to the abdominal wall, herniation through this muscular corset is a rare event and herniations nearly always occur through areas in which fibrous tissue has replaced muscle. When the tissues of a recurrent hernia or the type of hernia preclude a satisfactory repair, transposition of a thigh muscle, preferably the gracilis, will provide a dynamic repair that is superior to the introduction of foreign material with all its disadvantages or to the other approaches when local conditions are unsatisfactory. Clinical experience with seven procedures in six patients is presented as a preliminary report.