Recurrent inguinal herniorrhaphy: the centripetal approach utilizing a pre-formed polypropylene plug

Background Recurrence is the most common complication of inguinal herniorrhaphy and its mending carries an unacceptably high recurrence rate. During the development of a hernia clinic we initially repaired recurrent inguinal hernias using the Shouldice technique which requires complicated dissection followed by tissue approximation under tension. The necessary tissue exposure may injure anatomical elements incorporated into the scarred tissues. Methods and materials We progressively developed a modality that approaches the hernia sac directly, dissecting it centripetally up to the hernia's neck which was then occluded with a pre-formed polypropylene plug (233 patients). This technique, used for defects measuring up to 3 cm in diameter minimizes the dissection of tissues not involved in the repair reducing the chances of injury to nerves, vas deferent ducts, and veins. For defects larger than 3 cm, the posterior inguinal wall was mesh-reinforced utilizing the Rives or Kugel approaches (19 patients). Results The centripetal technique, used in the repair of 233 recurrent inguinal hernias produced three recurrences in a ten-year follow up. Incidences of infection, testicular ischemia, or disabling neuropathy were not observed. Conclusions In our hands the selective use of the centripetal technique produced good and reproducible results.