Mesh prosthesis versus triangular flap from the anterior sheath of the abdominal rectus muscle in primary inguinal hernia repair

A study was carried out to compare the use of two different tension-free surgical techniques, for the repair of primary inguinal hernia in cases without complications. The study was carried out on 91 consecutive patients who presented with primary and uncomplicated inguinal hernia. The patients were randomly divided into two groups. Group I consisted of 42 patients whose inguinal hernia was repaired by means of the application of a triangular flap rotated from the anterior sheath of the abdominal rectus muscle and then sutured to the inguinal ligament with noncontinuous and nonabsorbable suture 00. Group II consisted of 49 patients whose inguinal hernia was repaired by tension-free hernioplasty, placing a mesh umbrella plug in the deep inguinal orifice and, if necessary, mesh reinforcement to the floor of the inguinal canal (the Gilbert technique). There were no statistically significant differences with regard to age, sex, hernia evolution time, trans- or postoperative complications, or hernia recurrence during an average follow-up time of 3 years. Patients in the flap group required significantly more surgery time and postoperative analgesics. Cost analysis showed that patients receiving a muscle sheath flap spent less money on the actual surgical procedure, given the saving on the purchase of a prosthetic mesh. However, when taking into account the greater need for analgesia and the longer time in the operating theater, there was no difference in overall cost between the two procedures. Inguinal hernia repair using a triangular flap from the anterior sheath of the abdominal rectus muscle is an additional surgical procedure that can be utilized in cases where prosthetic mesh repair is not feasible.