Traditional Preperitoneal Approach to Inguinal Hernias

The preperitoneal approach desirably and advantageously permits direct exposure to transversalis fascia without disturbing the inguinal canal structures and allows restoration of the integrity of this layer in an anatomical, tension-free, and sutureless manner. The essential feature of prosthetic versus nonprosthetic repair of inguinofemoral hernias is the replacement of the transversalis fascia by a large mesh that extends far beyond the borders of myopectineal orifice and thus rendering the actual repair of myopectineal orifice unnecessary. Therefore, the indications for preperitoneal prosthetic repair include all recurrent and multiply recurrent groin hernias, and bilateral hernias in older patients.