Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

28. Prevention of Pain Optimizing the Open Primary Inguinal…
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it is the favored anesthesia in centers specializing in hernia surgery
[ 14 – 17 ]. The administration is technically quite easy but requires training
and is successful only if the surgeon handles the tissues gently, has
patience, and is competent and facile with the technique. Local anesthesia
should be the first option for inguinal hernia repair in the adult, but
sedation or general anesthesia with short-acting agents and combined
with local infiltration anesthesia may be a valid alternative to local anesthesia
alone for surgeons in training or outside of specialized hernia
centers [ 17 ].
Choice of Approach: Open Anterior Versus Open
Preperitoneal
In order to decrease the amount of dissection in the inguinal canal,
the manipulation of the inguinal nerves [ 18 ], and the interaction between
the foreign material of the mesh and the spermatic cord and nerves,
placement of the mesh in the preperitoneal space is an option to be considered
[ 19 ]. By placing the mesh in the preperitoneal space, a more
physiologic location for the mesh with intra-abdominal forces on one
side and the oblique muscles on the other, fixation becomes less mandatory
although may not be completely abandoned [ 19 ].
Usher et al. [ 20 ] introduced the prosthetic preperitoneal repair performed
through an anterior approach using polyethylene mesh (later
polypropylene), which was not slit because the spermatic cord was
lateralized. Mahorner and Goss [ 21 ] used anterior preperitoneal grafts
to support the overlying weakened transversalis fascia in two patients
with recurrent herniation and destruction of both Poupart’s and
Cooper’s ligaments. Rives [ 22 ] pioneered both anterior and posterior
preperitoneal prosthetic repairs of groin hernias in France using
Mersilene mesh. More recently Kugel (1999) employed this approach
through an abdominal gridiron incision, using a fortified patch to reinforce
the overlying damaged transversalis fascial floor of the inguinal
and femoral canals [ 23 ].
With regard to prosthetic preperitoneal repair through a posterior
approach, the precursor to modern laparoscopic techniques [totally
extraperitoneal repair (TEP), transabdominal preperitoneal repair
(TAPP), enhanced or extended view TEP (eTEP)], Stoppa et al. [ 24 ]
reported on the giant prosthetic reinforcement of the visceral sac
(GPRVS) in 1965. Large bilateral Dacron meshes were inserted deep