Regarding extremely large inguinal hernias with a contribution of two cases.

We report two men of ages 62 and 80 years, respectively, with giant inguinoscrotal hernias. They were operated with a single-stage repair by two approaches, extended preperitoneal of Nyhus and an inguinal method. After hernia content reduction, a policaproamide antimicrobial mesh Ampoxen (MEDICA SA, Sandanski, Bulgaria) with dimensions 20 x 30 cm was inserted by using Stoppa's technique. An additional inguinal reinforcement with other mesh patch was done on the external aponeurosis hernial defect. Synchronous orchiectomy and transscrotal drainage of both patients was performed. The first patient suffering from umbilical hernia was also operated at the same stage. He was prepared by preoperative pneumoperitoneum. The second patient, due to scrotal skin cellulitis with ulceration, was operated without pneumoperitoneum preparation. The latter created easier mobilization and reduction of the hernial content. The sizable mesh dimensions allowed, to some degree, an acceptable level of intra-abdominal pressure after the repair. These hernias demand interdisciplinary teamwork and their treatment has to be adapted to the individual condition of the patient using all therapeutic options.

Ultrasonographic characteristics of different methods of inguinal hernia repair.

A randomized blind sonography estimation analysis of seven different methods of inguinal hernia repair was performed using a commercially available linear scanner with a 5-MHz transducer frequency. A total of 58 male patients with a mean age of 56 years who had been free of recurrence since undergoing a hernia repair were examined 3-12 years after surgery. The analysis was accomplished by three static and four dynamic indices. A five-grade scale was used to assess the operated side while control pattern images of the unoperated operated side, and of a control group of five men who had not undergone surgery, were assessed with four points. The score from the static ultrasound assessment ranked the methods of Lotheissen-McVay and Shouldice first and the methods of Marcy and Postempsky-Halsted I second, while the score from dynamic indices ranked iliopublic tract repair and the methods of Marcy and Shouldice first and the method of Lotheissen-McVay and bilateral preperitoneal prosthetic repair second. The highest aggregate score was demonstrated by the Shouldice method and the lowest by Bassini's method. The results of this study provide additional information which may be clinically useful in the context of the current state of inguinal hernia surgery.

Possibilities of preperitoneal approach methods in the treatment of groin hernias. Preperitoneal approach methods.

A series of 93 patients operated on for groin hernias by applying the preperitoneal approach is reported (89 bilateral and four unilateral). The patients were divided into two groups. Group one included 24 patients without prosthetic repair. Group two included 65 patients who had undergone repair with Ampoxen mesh. Some untraditional methods are reported, such as interparietal repair, rotative transposition of external oblique muscle aponeurosis, etc. As far recurrences are concerned, no differences were recorded between the two groups (Pt greater than 0.05). Of all 193 groin hernias 81% were followed up and the total percentage of recurrences was 4.5%. Slight testicular and neuralgic postoperative complications were reported (three and two patients respectively). The advantages of biomaterials were confirmed by ultrasound examinations of ten patients from both groups. A conclusion is made that hernia repair strategy should be based on natural groin tissue resources.