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After reviewing the available classifications for groin hernias, the European Hernia Society (EHS) proposes an easy and simple classification based on the Aachen classification. The EHS will promote the general and systematic use of this classification for intraoperative description of the type of hernia and to increase the comparison of results in the literature. [ABSTRACT FROM AUTHOR]

The popular proverb that says “Happy people have no history” is not true. This short chronicle, from experience inside GREPA-EHS, by one of its founding members, tells the contrary to the reader. It suggests that, by meeting together, hernia surgeons got much welfare through scientific assessment, a more efficient practice, and increased recognition of their art. [ABSTRACT FROM AUTHOR]

This article discusses how biomaterials work in groin hernia repairs. A discussion of groin pain in athletes does not receive much attention in much of the surgical literature. Perhaps it is because a complaint of groin pain represents both a diagnostic and therapeutic challenge even to the most skilled surgeon or clinician. This is compounded by the fact that any discussion related to the groin region may be rather nebulous in terms of a clearly defined location or etiology.

The use of prosthetic materials is widely accepted for incisional and complex hernias, but the type of prosthesis in the abdominal wall still arouses acute controversy. We report an original experimental protocol testing three material placed intraperitoneally in the rat: a polyester mesh, a compound prosthesis (juxtaposition of a polyester mesh and a mesh of polyglactin 910) and a composite prosthesis (where fibers of polyester and polyglactin 910 were woven in the same mesh). There were two main criteria for assessment: the biologic tolerance to the material on the one hand, characterized histologically by the ratio of the surface of fibrosis to the surface of the inflammatory granuloma in contact with the material, and the nature of the adhesions between prosthesis and abdominal wall and the intraperitoneal viscera on the other. Statistical analysis of the results led to a preference for the homogeneous polyester prosthesis, compared with compound and composite prostheses (polyester and polyglactin 910) and to abandonment of the intraperitoneal site for insertion of such materials. [ABSTRACT FROM AUTHOR]

We have devised a reproducible approach to the preperitoneal space for laparoscopic repair of inguinal hernias that is based on an understanding of the abdominal wall anatomy. Laparoscopic totally extraperitoneal herniorrhaphy was performed on 99 hernias in 90 patients at the Los Angeles County–University of Southern California Medical Center, using a standardized approach to the preperitoneal space. Operative times, morbidity, and recurrence rates were recorded prospectively. The median operative time was 37 min (range, 28–60) for unilateral hernias and 46 min (range, 35–73) for bilateral hernias. There were no conversions to open repair, and there was only one conversion to a laparoscopic transabdominal approach. Complications were limited to urinary retention in two patients, pneumoscrotum in one patient, and postoperative pain requiring a large dose of analgesics in one patient. All patients were discharged within 23 h. There were no recurrences or neuralgias on follow-up at 2 years. A standardized approach to the preperitoneal space based on a thorough understanding of the abdominal wall anatomy is essential to a satisfactory outcome in hernia repair. [ABSTRACT FROM AUTHOR]

The easy performance and efficiency of these repairs is nonetheless accompanied by some drawbacks of which the surgeon should be aware. These may be discovered when reoperating on the bladder, prostate or iliac vessels. The difficulties are related to the extensive fibrosis involving the cave of Retzius and/or the space of Bogros. The authors report their intraoperative and anatomical findings. They propose the following solutions: 1. When cleavage of the cave of Retzius is impossible (in bladder or prostate surgery): a retropubic subperiosteal plane is developed, either isolated or combined with a transperitoneal approach. 2. When cleavage of the space of Bogros is impossible (in surgery on the iliac vessels): a transperitoneal approach is used. Prevention of fibrosis after the use of large prostheses can be achieved by preservation of the funicular sheath which protects the iliac vessels, providing no slit has been made in the mesh and by preservation of the umbilico-prevesical fascia. [ABSTRACT FROM AUTHOR]

Following an anatomic study of the spermatic sheath and in the light of anatomic dissections and frozen cadaver transverse sections, the authors define the inferior and lateral extensions of the fascia visceralis described by Couinaud and Mathis, especially into the Bogros (spermatic sheath), Retzius (umbilical-prevesical fascial), and retrorectal (retrorectal fascial) spaces. These points are important in hernia surgery when a large retroparietal prosthesis is used, in urologie surgery, and in carcinologic colorectal surgery. The anatomic relations with the other interparietal-peritoneal fasciae are also reviewed. [ABSTRACT FROM AUTHOR]

The authors have intraoperatively observed that the retroparietal components of the spermatic cord are contained within a spermatic sheath, the patency and morphology of which have been established. Anatomical dissections have identified its relations with the inter-parietoperitoneal fibrous structures, and the external iliac vessels. Careful preservation of this “spermatic sheath” during the mobilisation of the cord is recommended to avoid perivascular sclerosis due to contact with the large mesh prostheses used in groin hernia repairs. This is important to preserve as much sheath as possible and may be potentially useful if a reoperation is required for vascular surgery, organ transplant, or lymph node dissection. [ABSTRACT FROM AUTHOR]

A correction to the article "The European hernia society groin hernia classification: simple and easy to remember," which appeared in the March 19, 2008 issue is presented.

A letter to the editor is presented in response to the article "Anthropometric Characteristics of the Public Arch and Proper Function of the Defense Mechanisms Against Hernia Formation," by M. Lopez-Cano and colleagues in the November 2005 issue.

Presents a letter to the editor about prosthetic repair in contaminated areas.