Mesh Open Repair
 

Inguinal hernia repair today the most frequently performed the Lichtenstein repair. Flat mesh at the top of the defect.

Relief is "Free-tension" that does not place emphasis on the muscles, against Bassini and Shouldice suture repair (but there is a thread repair without tension, as Desarda). This is creating a network to strengthen the inguinal region. Usually, patients return home a few hours after surgery, often requiring no medication beyond acetaminophen (Tylenol / acetaminophen). Patients are encouraged to walk as soon as possible after surgery, and can usually resume normal activities within one or two weeks of operation. Complications include chronic pain (ranging from 10-50%, depending on the source), external sense of the body, stiffness, ischemic orchitis, testicular atrophy, dysejaculation, lack of ejaculation or painful ejaculation about 12%. Often reported. The rate of recidivism is low, <2%. In contrast, however, it is reported that benefits patients with pre-existing erectile dysfunction and sexual dysfunction in general.
 

Laparoscopic Repair
 

There are generally two methods of laparoscopic repair of: Transabdominal preperitoneal (TAPP) and totally extraperitoneal repair (TEP). When performed by a surgeon with experience in hernia repair, laparoscopic repair results in fewer complications than Liechtenstein, particularly less chronic pain. However, if the surgeon has experience in general laparoscopic surgery, but not the specific topic of laparoscopic hernia surgery, laparoscopic repair is not recommended, because it causes the risk of recurrence of Liechtenstein, while the risk of serious complications, such as organ damage. In fact, the TAPP approach should go through the stomach. That said, many surgeons are moving to laparoscopic methodologies such as the cause of smaller incisions, resulting in less bleeding, less infection, faster recovery, reduced hospitalization and reduced chronic pain.

There is no difference between the cost of laparoscopic and open repair increased operating expenses offset by a decrease in the recovery period. The level of return identical when laparoscopy is performed by an experienced surgeon. When performed by a surgeon with less experience in the tower repair of inguinal hernia, the return is higher than after Liechtenstein repair.
 

Meshes:
 

Trafficking Meshes are usually made of polypropylene or polyester. Marlex, Gore-Tex or Teflon mesh sold some businesses. Lightweight mesh seems to cause less discomfort than a serious Mesh. Some repair kits cap and patch are combined. 
 

Mosquito Nets

Mosquito net is a copolymer of polyethylene and polypropylene used for patients with low income in rural areas of India and Ghana. Each piece costs $ 0.01, 3700 times cheaper than commercial network equivalent. They give identical results, trade relations in terms of infection and recurrence rates at five years.
 

So it remains to show that, despite the considerably higher price, mesh trade rules could provide a practical improvement flies-net in the inguinal hernia operation.

Complications

Complications are common (> 10%). They include, but are not limited to foreign body sensation, chronic pain, ejaculation disorder, collapsible mesh net migration (meshoma) infection, adhesion formation, erosion d intraperitoneal organs. These complications usually become apparent weeks or years after the initial correction is introduced as abscess, fistula or intestinal obstruction.
 

Finally, polypropylene networks face degradation due to the effects of heat. This increases the risk of stiffness and chronic pain. Persistent inflammation and increased cellular traffic to interface the mesh fabric raised the possibility of malignant transformation.
 

If obstructive Azoospermia associated with polypropylene mesh used, due to obstruction of the vas deferens due to fibroblastic reaction network. However, a recent study showed that the risk appears to be less than 1%, and therefore does not need to be informed informed consent.
 

Absorbed Mesh
 

Boimeshes are increasingly popular since its first use in 1999 and the subsequent introduction of the market in 2003. Its use is an instance of regenerative medicine. Unlike synthetic nonabsorbable mesh, which are absorbed and can be used to repair an infected environment, as closed hernia. On the other hand, seems to enhance comfort and possibly reduce the risk of inguinodynia. They were tested after inguinodynia network chains. Some stitches have a price comparable to high-end synthetic mesh, the cheapest ($500) Surgisis Biodesign consists of extracellular matrix of porcine intestinal submucosa. Currently, there is a synthetic absorbed network completely, Tiger Matrix of 2010 and in the European market since 2011. It has a single proof of three years of pre-clinical sheep.
 

Despite his preference is not yet fully established, biological networks on the market increases, and if the current trend continues, you can replace the synthetic network in the United States in 2016.

The first effective repair of inguinal hernia is described Edoardo Bassini repair technique in 1880 Bassini is "tension", in which the edges of the defect and wire, without a net. The Bassini technique, United tendons (formed by the distal ends of the inner hair and transverse abdominal muscles), joined the inguinal ligament and closed. Today, the main interest Bassini is historic. Yet it has in some developing countries, if surgeons are not aware of the alternatives Lichtenstein mesh repair purely commercial, or if repairs are not included in the base more effectively seam.
 

McVay/Cooper’s Ligament
 

Under the channel is enhanced access to the abdominal fascia and fascia cross pectinate ligament (Cooper) medially to the pubic bumps in the femoral vein. Side this plant is restored so that the inguinal ligament femoral sheath. It is also used in the repair of femoral hernia.
 

Shouldice
 

Shouldice technique with traditional surgical repair is based. There is also a reconstruction of four relatively hard layers of cross-belt; However, it was reported a relatively low rate of recurrence in the hand surgeon with experience with this method.
 

Shouldice repairs are used less frequently than in previous years, especially in developed countries. This is mainly because the basic method of network Lichtenstein is easier to achieve. Shouldice repair has a higher rate of recurrence hernia in the hands of inexperienced surgeons with them (<200 operations / year). Another disadvantage is the post-operative pain due to tension in the muscles, which usually takes a few weeks. However, this pain and manage the pain, and that short-term pain should be balanced with a much lower risk of long-term pain Shouldice technique, which is half of Liechtenstein (or similar laparoscopic) This is why some tension repairs are still in use today; These include the Shouldice and ligament/McVay repair Cooper.
 

The main advantage Shouldice technique remains relatively low compared to chronic pain (10% of cases) with respect to the repair based on an open network (Lichtenstein) (20% of cases). However, the risk of chronic pain with this method is comparable to the laparoscopic repair by an experienced repair of inguinal hernia operation (ie> 200 hernia / year) (8% infestation) (and not only by experienced laparoscopic surgeons. This distinction is important).
 

Also, if the surgeon does not have enough experience with the Shouldice technique, as is the case with most surgeons today can advise based network repairs. For example, in developing countries, where commercial screens are expensive, but where surgeons may also be less qualified, screen repair windows open network can be better than Shouldice. In fact, both have a similar cost (one mosquito net costs less than $ 0.01 a network. Its sterilization costs less than $ 1), and mesh repair is easier to perform than Shouldice. Desarda repair is also another option, but it is less well known.
 

Another advantage of repair is based on correcting the network permanently seam introduces a foreign body material significant permanent, at worst, only polypropylene nonabsorbable sutures. Permanent networks can lead to further complications in the long run, because of that fact.
 

Desarda emerging suture technique is a technique based. This can be done with sutures absorption. It is easier and faster to understand that the Shouldice and Lichtenstein. Lichtenstein gives similar results in terms of return, with the significant advantage of not introducing foreign substances permanent body. In addition, this technique is no tension, no network, and focus on the physiology borrows. Other techniques used by the flap of the external oblique belt proposed independently by other surgeons.
 

Guarnieri
 

Guarnieri technique appeared in 1988. It can be used with or without a network. As Desarda techniques, methods Guarnieri pays attention to physiology, but also energized.