TRANSINGUINAL PREPERITONEAL MESH PROSTHES IS FOR THE REPAIR OF RECURRENT INGUINAL-HERNIA

From 3 years' experience with nearly 100 transinguinal preperitoneal m esh prosthesis (TIPP) repairs for recurrent inguinal hernia the indica tion, anesthesia. modification of the technique, and results are repor ted. After intraoperative classification of the hernia, the TIPP repai r is indicated especially in large defects of the posterior wall (L/M III). The procedure is easily performed under local anesthesia. During 52 local TIPP repairs, conversion of anesthesia was never necessary. Important technical details include the requirement for a sufficient s ize of mesh (10 cm x 15 cm) and a certain caudal and cranial fixation of the prosthesis using at least three interrupted stitches for each. Apart from an increased number of seromas (12%) in the early postopera tive period, the results of the TIPP are comparable with, those obtain ed after Shouldice repair for recurrent hernia. The rate of hematomas, infections, and testicular complications range between 1% and 3%. Con sidering the negative case selection of only large recurrent hernias, the TIPP repair reveals a favourably low 1-year recurrence rate of 1%.