[An anatomicophysiological validation of hernioplasty in inguinal hernias]

Contemporary understanding of the pathogenesis of inguinal hernias modifies the approach to solution of the problem from elementary anatomical to anatomical and functional. This in turn implies a number of specific demands on their treatment, such as: 1) preserving the oblique course of the canal in the abdominal wall, 2) endeavours to utilize the functionally synergetic elements of the respective layer for plastic repair of the defect, and 3) attempt at noninterference with the pump-valve function of the canal during plastic modelling of either of the openings. In both types of inguinal hernia, posterior plasties are pathogenetically justified. Positive experience had with 37 patients, operated for inguinal hernia after the methods of Shouldice, McVay and Kukudzhanov, or by combining single elements of the latter, is shared. The series analyzed comprises 18 cases presenting indirect hernia, 8-direct, 8-simultaneously direct and indirect, and 3-recurrent hernia. The extrafascial access to Cooper's ligament described contributes to the beneficial outcome.