Mesh between the oblique muscles is simple and effective in open hernioplasty

Controversy exists as to the best position for insertion of the mesh patch in open inguinal herniorrhaphy. The "inlay" mesh graft, which is laid under the transversalis fascia, has been considered preferable by some authors. But in the Lichtenstein open tension-free inguinal hernia repair, the mesh is preferably placed under the external oblique aponeurosis. It is not an "onlay graft" because it lies under the external oblique and over the internal oblique muscles and transversalis fascia. The possible development of an "interstitial" hernia is without basis and has never been seen. This particular "onlay graft" (more correctly an intermuscular graft) is much simpler to apply and has resulted in almost no recurrences and side effects. Placing the patch between the two oblique muscles is therefore recommended for open tension-free primary inguinal hernioplasties.