Bertone S. Editorial: resultados de la uꢁlización de malla única en la reparación de hernias inguinales. Rev Argent Cir 2022;114(1):5-7
Inguinalherniarepairisoneofthemostcommon of the prostheꢀc material migraꢀon . This technique
surgical procedures performed worldwide. With the reminds us of the Stoppa technique which, like all
incorporaꢀon of prostheꢀc mesh, the Liechtenstein preperitoneal techniques via the anterior approach, fell
technique became the gold standard technique for into disuse with the advent of laparoscopy.
primary hernia repair, due to its low recurrence rate,
In this same work, the authors propose
low complicaꢀons, and its reproducibility at low to demonstrate the safety and eﬃcacy in terms of
recurrence, postoperaꢀve pain and costs of the use of
Since the advent of laparoscopic surgery and a single mesh in the repair of direct bilateral inguinal
its implementaꢀon in inguinal hernia repair, its beneﬁts hernias laparoscopically. The results observed are very
in terms of postoperaꢀve pain, return to work and good, although, as it is a retrospecꢀve series of cases
cosmeꢀc results have been demonstrated. In addiꢀon, without a control group, it is not feasible to reach
the recurrence rate and complicaꢀons are similar to conclusions that demonstrate its superiority to the
those of the convenꢀonal techniques .
usual technique and therefore cannot be extrapolated
The excellent outcomes obtained with to a change in the usual pracꢀce.
laparoscopic techniques in experienced surgeons are
As the authors correctly menꢀoned, other
due to the technical developments observed over the groups have addressed the theoreꢀcal advantages of
the single-mesh technique. Apart from the publicaꢀons
8 9 10 11
The need for understanding the posterior by Deans , Champault , Rihan and Ohana , the
anatomy and, through a proper dissecꢀon, achieving studies by Issa et al.12 in 2016 and Halm et al. in 2005
the criꢀcal view of safety, are of crucial importance . are worth menꢀoning. Both are retrospecꢀve studies
Dissecꢀon should create suﬃcient space to that failed to demonstrate signiﬁcant diﬀerences in
accommodate a mesh that descends 2 cm below the terms of postoperaꢀve complicaꢀons, recurrence or
pubis and crosses over 2 cm to the contralateral area. pain. Therefore, the theoreꢀcal beneﬁts have not been
As a result, the minimum mesh size is currently 15 × demonstrated either in this or in other studies, and the
2 cenꢀmeters. In case of bilateral hernias, meshes choice of this technique is leꢂ on the discreꢀon of the
should overlap in the midline. In this way, two of the surgeon’s preference without changing the short or
main risk factors for recurrence, insuﬃcient dissecꢀon long-term outcomes.
and placement of small meshes, have been addressed
For this reason, nowadays the correct surgical
technique with a wide dissecꢀon, a mesh with adequate
In the arꢀcle published in this issue, the authors overlapping and, if necessary, crossing over with the
propose the placement of a large preperitoneal mesh, contralateral mesh, are sꢀll the key elements to achieve
which would have the beneﬁt of less recurrence, thanks the excellent results obtained with laparoscopic
to the reducꢀon of concentric retracꢀon and the risk techniques.
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