Difficult hernia repair in the elderly : a particular case

A particular clinical case personally observed is described. On the basis of this case it is evaluated if it can be correct to implant a mesh in potentially contaminated areas, if preperitoneal repair is the best approach in recurrent or difficult hernia repair and if there are specific contraindications in operating elderly patients

Open sutureless tension-free repair for primary inguinal hernia

Since the first hernioplasty performed by Edoardo Bassini in 1884, all surgical reconstruction techniques have suffered from a common defect: tension on the suture line. This represents the main etiologic factor for recurrent hernia. With the introduction of modern prosthetic materials (meshes and plugs) it is possible to perform all hernia repairs without altering the normal anatomy, as well as avoiding undesired suture line tensions. Between January 1 1992 and December 1998 1405 open sutureless tension-free repairs were performed for primary inguinal hernia in 1317 patients. The number of patients treated with local anesthesia was 1235 (93 8%), with 63 (4 8%) treated under general anesthesia, and 19 (1.4%) with epidural anesthesia. In this series only 4 (0.3%) cases of intra-operative complication occurred (vagal crisis without consequences for the patients). Nine (0.6%) cases of early postoperative complications were noted, of which 8 involved vagal crisis and 1 hemorrhage. Forty six (3.4%) late postoperative complications occurred: 32 seromas accompanied by 3 massive inguino-scrotal edemas, 4 hematomas, and 10 wound infections without the necessity to remove the mesh in all cases. Six recurrences (0.4%) were noted after primary surgical repair. Mean follow-up time was 4 years (range 1-7 years). The proposed technique is simple, safe, and characterized by a rapid performing procedure giving an excellent outcome. The data presented confirms the experience of others reported in the world literature, with a low complication rate and lower cost for the communit