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A D V E R T I S E M E N T
A D V E R T I S E M E N T
In order to do a pectineal ligament repair, the properitoneal fat must be swept up off the transversalis fascia covering pectineal ligament. This also exposes the iliac vessels and the upper end of the femoral canal. The pectineal ligament is about two centimeters deeper than the inguinal ligament.
A D V E R T I S E M E N T
In order to bring the falx back to the pectineal ligament without tension, a relaxing incision is made in the deep layer of anterior rectus sheath in the cleft beneath external oblique aponeurosis. The falx is sutured to pectineal ligament up to the rim of the femoral canal where a transition stitch makes the jump from the deeper pectineal plane to the level of the iliopubic tract and inguinal ligament. The remainder of the suture line is completed as in the iliopubic tract repair.
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A D V E R T I S E M E N T
The "tension-free" prosthetic mesh onlay repair (Lichtenstein) is done by suturing non-absorbable mesh anteriorly over the inguinal floor. Tails of mesh are sutured around the cord to create a snug internal ring. The mesh becomes incorporated by tissue ingrowth.
One other type of open hernia repair, the preperitoneal mesh repair (Stoppa) has been superseded by the laparoscopic placement of mesh. A hybrid minimally invasive preperitoneal mesh repair (Kugel) has recently been introduced which has the advantages of the anterior and posterior approaches without the disadvantages of large incision and laparoscopic technology.
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This page was last modified on 1/31/1999.
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