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Open techniques of inguinal and femoral hernia repair in adults

Open techniques of inguinal and femoral hernia repair in adults
Repair Type Description Recurrence rate Comments
Lichtenstein Mesh repair Flat mesh placed anterior to the transversalis fascia <1% to 5% Most studied technique for open inguinal hernia repair
Preperitoneal Mesh repair Flat mesh placed posterior to the transversalis fascia (eg, Nyhus, Rives-Stoppa, Read, Wants, Kugel repairs) <1% to 4% Posterior repair recommended for femoral hernias
Plug and patch Mesh repair Mesh plug placed through the defect; flat mesh placed anterior to the transversalis fascia 4% Plugs can migrate or cause chronic pain
Bilayer Mesh repair Two-layer meshes placed anterior and posterior to the transversalis fascia <1% to 3% A flat mesh in a single plane is the preferred mesh repair
Shouldice Nonmesh repair Four-layer overlapping reconstruction using continuous fine wire sutures <1% to 7% The best evaluated and best standardized nonmesh repair, has lowest recurrence rate of all nonmesh repairs
Desarda Nonmesh repair Use a flap of the external oblique muscle aponeurosis to "patch" the defect 1.4% to 4.2% Favorable preliminary results but lacking high-quality long-term data
Bassini Nonmesh repair Suturing the conjoined tendon to the inguinal ligament 5% to 15%  
McVay Nonmesh repair Suturing the conjoined tendon to the Cooper's ligament and inguinal ligament, with a relaxing incision of the anterior rectus sheath 5% to 15% The only nonmesh repair for femoral hernias
References:
  1. Woods B, Neumayer L. Open repair of inguinal hernia: An evidence-based review. Surg Clin North Am 2008; 88:139.
  2. Pathak AA, Fouzdar A, Kumar K, et al. Long term outcomes after surgery for inguinal hernia: A retrospective cohort study comparing outcomes of Desarda and Lichtenstein repairs with three years of follow-up. Maedica (Bucur) 2024; 19:573.
  3. Pompeu BF, Pasqualotto E, Marcolin P, et al. Desarda versus Lichtenstein inguinal hernia repair: A meta-analysis of randomized controlled trials. World J Surg 2024; 48:2615.
  4. Stabilini C, van Veenendaal N, Aasvang E, et al. Update of the international HerniaSurge guidelines for groin hernia management. BJS Open 2023; 7:zrad080.
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