The use of fascial graft in the cure of inguinal hernia

Abstract

SURGEON, HOVE GENERAL HOSPITALAN investigation in 1931 of the literature suggested to the writer that in the majority of the papers on inguinal hernia the high percentage of recurrence after operation constituted a reproach to modern surgery, and the inadequacy of the average follow-up led one to presume that the true recurrence figure might be still higher.This paper shows the results of a personal consecutive non-selected series of 163 elective (non-strangulated) operations for inguinal hernia with as adequate a follow-up as possible. I have set out to stress the need for fuller after-investigation and to advocate the more extensive use of the fascia lata graft technique. HISTORICAL As far back as 1901McArthurZ7 started to use fascia to supplement the methods then in use. He freed one end of a strip from the external oblique aponeurosis, and with it he darned across between the falx inguinale and the inguinal ligament. With a second similar strip, tethered still at one end to the parent external oblique, he closed the incision in that muscle.In 1910 Kirschner20 recorded a number of successes with free flap transplants of fascia lata sutured across the weak posterior wall of the inguinal canal. He claimed for fascia lata its accessibility, abundance, strength, inelasticity, and readiness to heal in when transplanted, and that it could be cut to fit an opening of any shape. It was in 1921 that Gallie and Lemesurier14 demonstrated the survival of long free fascial strips (6 or 7 in. by in.), and advocated their use in preference to flaps of fascia. They introduced a special curved, large-eyed needle on which the strip is threaded, and using this material a ' darn ' is made across the weak area. He published his findings in 1904.This work laid the foundation of the modern graft operation. METHODS OF TREATMENT