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

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into the weakened transversalis fascia, covering Fruchaud’s myopectineal
orifice with extensive overlap. This operation provided an alternative to
the anterior preperitoneal approach, which, in cases of recurrent herniation,
encounters scarring possibly leading to damage of the spermatic
cord, nerves, and blood vessels. Wantz [ 25 ] proposed a unilateral version
of this operation, reaching the preperitoneal spaces of Bogros and
Retzius using a transverse incision extending laterally 9 cm from the
linea alba and 3 cm below the anterior superior iliac spine.
Gilbert [ 26 ] developed a two-layered prosthesis; the superficial portion
rests on the transversalis fascial floor of the inguinal canal, while
the lower portion lays beneath in the anterior preperitoneal space. The
patches were connected by a plug that passed through the internal inguinal
ring. A slit in the onlay portion allowed for passage of the spermatic
cord to the inguinal canal below the external oblique aponeurosis.
Widespread release of the device from its manufacturer (1998) led to the
technique being called the Prolene Hernia System (PHS).
More recently the transinguinal preperitoneal repair (TIPP) technique
had been proposed by Pellisier [ 27 ]: this technique involves a standard
anterior approach through the inguinal canal where a patch with a
memory ring is placed into the preperitoneal space behind the transversalis
fascia. Willaert et al. [ 19 ] recently proposed with the Cochrane
collaboration a review with the aim to compare the efficacy of an elective
open preperitoneal mesh repair via either anterior or posterior
approach with the Lichtenstein technique . Efficacy was considered as
the absence of chronic pain after at least three months of follow-up. All
published and unpublished randomized controlled trials (RCTs) comparing
any elective open preperitoneal mesh technique with Lichtenstein
repair were considered for inclusion. Strangulated inguinal hernias,
bilateral inguinal hernias, and recurrent inguinal hernias were exclusion
criteria.
Unfortunately, many studies did not address the primary outcome of
the review and only three studies were included. In these three trials, the
Lichtenstein technique was compared with Read-Rives technique [ 28 ],
TIPP [ 19 ], and Kugel patch [ 29 ]. The last two studies reported less
chronic pain after preperitoneal repair; however, the Muldoon study
described slightly more chronic pain after preperitoneal repair. Few data
are present in the literature about chronic pain after Wantz posterior
preperitoneal repair: this technique is usually used in the specialized
hernia center for the treatment of very large, incarcerated hernias, recurrent
hernias, femoral hernias, or in the treatment of postoperative
chronic pain [ 30 ].