[Implantation of alloplastic surgical mesh in hernia repair. An anterior pre-peritoneal approach]

Despite the fact that more than one century has passed from the first radically performed surgery of inguinal hernia by Bassini there is still an appreciable problem in repair of abdominal hernias. In reconstructive-plastic surgeries, without the application of prosthesis, recurrences amount to 10% in primary repairs, and up to 20% or more in repairing recurrences. Synthetic surgical meshes have been used in repair of hernias for over 4 decades. During that period, extensive experience has been gained in use of various kinds of nonabsorbent and absorbent synthetic meshes in either experimental animals or in clinical investigations. Following our experience with one hundred patients managed with dacron "Mersilene" mesh, throughout the period 1960-1974, we were very rigorous, i. e. we used synthetic meshes only in cases when defect could not be repaired by the tension-free living tissue from the surrounding area. Today, synthetic meshes are routinely used for almost all kinds of hernias and even in primary reconstruction of inguinal and femoral hernias without the plastic surgery of the surrounding tissue. During the past 20 years, Lichtenstein IL, Shulman AG, Parviz KA et al. from Los Angeles have been recommending "the tension-free hernioplasty" for the repair of all kinds of primary and recurrent hernias with the results (infections, recurrences) being far more better than those achieved with the old classical operations. At present, the polypropylene "Marlex" mesh sewn with monofilamented polypropylene threads yields very good results and should be found in the hands of every surgeon practitioner.