The Types of Non-Mesh Hernia Repairs
There are numerous ways to repair an inguinal hernia with the local soft tissue. The Bassini technique repairs the inguinal floor by sewing together the transversalis fascia and the inguinal ligament. Then the external oblique is repaired over the spermatic cord. This is a classic technique that has been used for over a hundred years. The repair has excellent results. The drawback is a moderate amount of tension on the repair. This tension causes more post op pain and can prolong the recovery.
The Shouldice hernia repair involves using a running suture to first plicate and strengthen the inguinal floor. And then a second running suture is used to plicate and the oblique muscles. This results in a four-layer repair. There is minimal tension of the repair. The recurrence rate for the Shouldice repair is equal to or better than the mesh repairs. This is an excellent technique for hernia repair.
The Marcy hernia repair is designed for indirect hernias. It involves separating the hernia sac from the spermatic cord. Then tying off hernia sac and allowing the stump to retract back into the retroperitoneal space. Internal ring is then tightened with a few sutures. The external oblique aponeurosis is then repaired. There is no tension on the repair. The post-operative pain is minimal and there is a quick recovery. The results are excellent.
The Desarda hernia repair uses the external oblique aponeurosis as a patch to reinforce and repair the inguinal floor. (Note: this is similar to a mesh hernia repairs, but your own tissue is used instead of plastic.) The remaining sections of the external oblique aponeurosis are closed over the spermatic cord and to finish up the repair. The results are excellent. The recurrence rates are low. There is minimal tension on the repair.
The McVay hernia repair has been used by surgeons for over 50 years. The McVay hernia repair is unique in that it uses the Cooper’s Ligament instead of the inguinal ligament to repair the inguinal floor. For example, with the Bassini repair the transversalis is sewn to the inguinal ligament. But in the McVay repair, the transversalis fascia is sewn to Cooper’s ligament medially and then to the inguinal ligament laterally. The McVay repair is very helpful in situations where the inguinal ligament is weak or absent. And it is the preferred method when a femoral hernia is present. There can be a moderate amount of tension on the repair. And often a relaxing incision is required. There will be more pain and a slower recovery.
Learn more about Dr. Brown’s approach to hernia repair without mesh. Contact Dr. Brown today.