Inguinal herniorrhaphy with an undetached strip of external oblique aponeurosis: A new approach used in 400 patients

Abstract

Objective: To describe my experience with a technique of hernia repair in which the posterior wall of the inguinal canal is strengthened with an undetached strip of the external oblique aponeurosis to give physiologically active and strong posterior wall. Design: Retrospective open study. Setting: Medical college and district hospital, India. Subjects: 400 patients operated on 1983-99, 106 of whom have been followed up for more than 10 years. Intervention: After the sac has been excised, a strip of external oblique aponeurosis is partly separated from its medial leaf, keeping its continuity intact at either end. This is sutured to the inguinal ligament below, and the arch of the muscle above, behind the cord, to form a new posterior wall. Main outcome measures: Morbidity and hospital stay. Results: No patient had severe pain postoperatively and nearly all patients (n = 396) were free of pain and discomfort after the second postoperative day. 340 patients (85%) were discharged by the 4th postoperative day, and most returned to normal activities within two weeks. There was one early haematocoele, and 1 recurrence at 2 years. Conclusions: The operation is easy to do, does not require mesh, and gives results equivalent to those reported for mesh. It is therefore a good option for repair of an inguinal hernia.