Preperitoneal Open Repair of Groin Hernias Using Prosthetic Reinforcement

  • Martin Kurzer


Open preperitoneal mesh repairs of groin hernias place non-absorbable mesh through an abdominal incision in a plane outside the peritoneal cavity, between the peritoneum and the anterior abdominal wall. The ‘classical’ preperitoneal repairs were developed just prior to the laparoscopic era as a way of dealing with difficult recurrent groin hernias with extensive scarring and tissue loss. Newer open preperitoneal techniques are being advocated for primary inguinal hernia repair, devised in the expectation of reducing the incidence of long-term post-operative discomfort that is possibly related to the presence of mesh in the inguinal canal. This chapter reviews the history and development of the classical approach and describes the newer small incision techniques with their reported results. While it remains to be seen whether or not these newer methods prove their usefulness in everyday general surgical practice, the classical operations remain a useful technique even in the laparoscopic era and should have a place in the toolkit of every surgeon who declares an interest in hernia surgery.


  1. 1.
    Cheatle GL. An operation for radical cure of inguinal and femoral hernia. Br Med J. 1920;2:68–9.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Henry AK. Operation for femoral hernia by a midline extraperitoneal approach: with a preliminary note on the use of this route for reducible inguinal hernia. Lancet. 1936;1:531–3.CrossRefGoogle Scholar
  3. 3.
    Read RC. Use of the preperitoneal space in inguinofemoral herniorrhaphy. Historical considerations. In: Bendavid R, et al., editors. Abdominal wall hernias. Principles and management. New York: Springer-Verlag; 2001. p. 11–5.CrossRefGoogle Scholar
  4. 4.
    Nyhus LM, Condon RE, Harkins HN. Clinical experience with preperitoneal hernia repair for all type of hernia of the groin. Am J Surg. 1960;100:234.CrossRefGoogle Scholar
  5. 5.
    Read RC. Preperitoneal exposure of inguinal herniation. Am J Surg. 1968;116:653.CrossRefGoogle Scholar
  6. 6.
    Stoppa RE, Petit J, Henry X. Unsutured Dacron prosthesis in groin hernias. Int Surg. 1975;60:411–2.Google Scholar
  7. 7.
    Wantz GE. Testicular atrophy as a sequela of inguinal hernioplasty. Int Surg. 1986;71:159–63.Google Scholar
  8. 8.
    Nyhus LM. Iliopubic tract repair of inguinal and femoral hernia: the posterior preperitoneal approach. Surg Clin N Am. 1993;73:487.CrossRefGoogle Scholar
  9. 9.
    Stoppa R, et al. Prosthetic repair in the treatment of groin hernias. Int Surg. 1986;71:154–8.Google Scholar
  10. 10.
    Rives J. Surgical treatment of the inguinal hernia with Dacron patch: principles, indications, technic and results. Int Surg. 1967;47:360–2.Google Scholar
  11. 11.
    Fruchaud H. Anatomie chirurgicale des hernies de l’aine. Paris: G Doin; 1956.Google Scholar
  12. 12.
    Wantz GE. Prosthetic repair groin hernioplasties. In:Atlas of hernia surgery. New York: Raven Press; 1991. p. 94–151.Google Scholar
  13. 13.
    Rignault DP. Properitoneal prosthetic inguinal hernioplasty through a Pfanenstiel approach. Surg Gynecol Obstet. 1986;163:465–8.Google Scholar
  14. 14.
    Wantz GE. Giant prosthetic reinforcement of the visceral sac. Surg Gynecol Obstet. 1989;169:408–17.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Arlt G, Schumpelick V. Transinguinal preperitoneal mesh-plasty (TIPP) in management of recurrent inguinal hernia. Chirurg. 1997;68:1235–8.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Pelissier E, et al. Inguinal hernia: a patch covering only the myopectineal orifice is effective. Hernia. 2001;5:84–7.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Read RC. Bilaterality and the prosthetic repair of large recurrent inguinal hernias. Am J Surg. 1979;138:788–93.CrossRefGoogle Scholar
  18. 18.
    Stoppa R, et al. The use of Dacron in the repair of hernias of the groin. Surg Clin N Am. 1984;64:269–85.CrossRefGoogle Scholar
  19. 19.
    Kurzer M, Belsham PA, Kark AE. Prospective study of open preperitoneal mesh repair for recurrent inguinal hernia. Br J Surg. 2002;89:90–3.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Ugahary F, Simmermacher RKJ. Groin hernia repair via a gridiron incision: an alternative technique for preperitoneal mesh insertion. Hernia. 1998;2:123–5.CrossRefGoogle Scholar
  21. 21.
    Stoppa R. Reinforcement of the visceral sac by a preperitoneal bilateral mesh prosthesis in groin hernia repair. In: Bendavid R, Abrahamson J, Arregui ME, Flament JB, Phillips EH, editors. Abdominal wall hernias: principles and management. New York: Springer; 2001. p. 428–36.CrossRefGoogle Scholar
  22. 22.
    Stoppa R. The preperitoneal approach and prosthetic repair of groin hernias. In: Nyhus LM, Condon RE, editors. Hernia. Philadelphia: J B Lippincott Co.; 1995. p. 188–210.Google Scholar
  23. 23.
    Lowham A, et al. Mechanisms of hernia recurrence after preperitoneal mesh repair. Ann Surg. 1997;225:422–31.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Kugel RD. Minimally invasive, nonlaparoscopic, preperitoneal, and sutureless inguinal herniorrhaphy. Am J Surg. 1999;178:298–302.CrossRefGoogle Scholar
  25. 25.
    Koning GG, Andeweg CS, Keus F, et al. The transrectus sheath preperitoneal mesh repair for inguinal hernia: technique, rationale, and results of the first 50 cases. Hernia. 2012;16:295–9.CrossRefGoogle Scholar
  26. 26.
    Lourenço A, da Costa RS. The ONSTEP inguinal hernia repair technique: initial clinical experience of 693 patients, in two institutions. Hernia. 2013;17:357–64.CrossRefGoogle Scholar
  27. 27.
    Lorenz D, Stark E, Oestreich K, Richter A. Laparoscopic hernioplasty versus conventional hernioplasty (Shouldice): results of a prospective randomized trial. World J Surg. 2000;24:739–45.CrossRefGoogle Scholar
  28. 28.
    Greenburg AG. Should we be wary of hernia mesh devices with reinforcement? Hernia. 2013;17:355–6.CrossRefGoogle Scholar
  29. 29.
    Andresen K, Rosenberg J. Open preperitoneal groin hernia repair with mesh: a qualitative systematic review. Am J Surg. 2017;213(6):1153–9.CrossRefGoogle Scholar
  30. 30.
    Schumpelick VCJKU. Preperitoneal mesh-plasty in incisional hernia repair. A comparative retrospective study of 272 operated incisional hernias. Chirurg. 1996;67:1028–35.CrossRefGoogle Scholar
  31. 31.
    Rosin D. Trans-rectus sheath extra-peritoneal procedure (TREPP) for inguinal hernia – commentary. World J Surg. 2014;38:1929–30.CrossRefGoogle Scholar
  32. 32.
    Ugahary F. The gridiron hernioplasty. In:Abdominal wall hernias. Principles and management. New York: Springer-Verlag; 2001. p. 407–11.CrossRefGoogle Scholar
  33. 33.
    Nienhuijs S, et al. Pain after open preperitoneal repair versus Lichtenstein repair: a randomized trial. World J Surg. 2007;9:1751–7.CrossRefGoogle Scholar
  34. 34.
    van Nieuwenhove Y, et al. Open preperitoneal hernia repair with the Kugel patch: a prospective, multicentre study of 450 repairs. Hernia. 2007;11:9–13.CrossRefGoogle Scholar
  35. 35.
    Fenoglio ME, et al. Inguinal hernia repair: results using an open preperitoneal approach. Hernia. 2005;9:160–1.CrossRefGoogle Scholar
  36. 36.
    Suwa K, Nakajima S, Hanyu K, et al. Modified Kugel herniorrhaphy using standardized dissection technique of the preperitoneal space: long-term operative outcome in consecutive 340 patients with inguinal hernia. Hernia. 2013;17:699–707.CrossRefGoogle Scholar
  37. 37.
    Baroody M, Bansal V, Maish G. The open preperitoneal approach to recurrent inguinal hernias in high-risk patients. Hernia. 2004;8:373–5.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Schroder D, et al. Inguinal hernia recurrence following preperitoneal Kugel patch repair. Am Surg. 2004;70:132–6.PubMedPubMedCentralGoogle Scholar
  39. 39.
    Lange JFM, Lange MM, Voropai DA, et al. Trans rectus sheath extra-peritoneal procedure (TREPP) for inguinal hernia: the first 1,000 patients. World J Surg. 2014;38:1922–8.PubMedPubMedCentralGoogle Scholar
  40. 40.
    Willaert W, De Bacquer D, Rogiers X, et al. Open preperitoneal techniques versus Lichtenstein repair for elective inguinal hernias. Cochrane Database Syst Rev. 2012;7:CD008034. Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.St John and St Elizabeth HospitalLondonUK

Personalised recommendations