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- •Foreword
- •Preface
- •Contents
- •1: History and Evolution of Hernia Surgery
- •References
- •2.1 Introduction
- •3.2.2 Matrix Metalloproteinases (MMPs)
- •3.2.3 Growth Factors
- •References
- •3.1 Introduction
- •3.2.1 Collagen Fibers
- •3.2.4 Elastic Fibers
- •3.3 Discussion
- •References
- •References
- •5.1 Introduction
- •5.3.2 Ultrasound
- •5.3.3 CT Scan
- •5.3.4 MRI
- •5.3.5 Herniography
- •5.3.6 Diagnostic Laparoscopy
- •References
- •6.1 Prosthetic Mesh Materials
- •6.1.1 Introduction
- •6.1.3.1 Wound Healing Process
- •6.1.3.2 The Foreign Body Reaction
- •6.1.4 The Ideal Prosthetic Mesh
- •6.2 Mesh Properties
- •6.2.1 Materials
- •6.2.1.1 Plastic (Synthetic) Meshes: Non-Absorbable
- •Polypropylene Mesh (PPM)
- •Polyester Mesh
- •ePTFE
- •cPTFE
- •PVDF
- •Polyglycolic Acid
- •Polyglactin 910
- •6.2.1.4 Composite/Hybrid Meshes
- •6.2.1.5 Biological Meshes
- •6.2.1.6 Cross-Linked Vs. Non-Cross-Linked
- •6.2.2 Mesh Construction
- •6.2.6.1 Low-Cost Mesh
- •6.3.1 Introduction
- •6.3.2 Fixation Methods
- •6.3.2.1 Suture Fixation
- •Suture Material
- •Suture Technique
- •6.3.2.2 Glue Fixation
- •6.3.2.3 Fibrin Sealant Fixation
- •6.3.2.4 Staple Fixation
- •6.3.2.6 No Fixation
- •6.3.2.7 Self-Fixing Mesh
- •References
- •7.1 Introduction
- •7.2.3 Other Tools
- •7.2.5.2 Group Members
- •7.2.6 The GRADE Approach
- •References
- •8.1 Introduction
- •8.4 Registry-Based Research
- •References
- •9.1 Introduction
- •References
- •10.1 Background
- •10.2 Trends
- •10.3 The Mesh Implant
- •10.5.1 Day Surgery
- •10.5.2 Laparoscopic Ventral Hernia Surgery
- •10.6 Actual Situation
- •10.6.1 Innovative Surgical Techniques
- •10.6.2 Sub-Specialisation
- •References
- •11.1 Hernia Epidemiology
- •11.1.1 Groin Hernia
- •11.1.2 Ventral Incisional Hernia
- •11.2 Pre-Habilitation
- •11.3 Operative Techniques
- •11.5 Robot-Assisted Hernia Repair
- •References
- •12.1 Introduction
- •References
- •13.4.1 Inguinal Hernia Repair
- •13.4.3 Incisional Hernia Repair
- •13.5 Laparoscopic Training
- •13.6 TAPP Versus TEP
- •13.7 Open Inguinal Hernia Repair
- •13.8 Mesh Controversy
- •References
- •14.1 Summary
- •15: Humanitarian Hernia Surgery: Lessons Learned
- •15.1 Introduction
- •15.2 Service Missions
- •15.2.1 Surgeon Selection
- •15.4.4 Surgeon Trainee Selection
- •References
- •15.3.5 Incisional Hernias
- •15.3.6 Anesthesia Care
- •15.3.7 Patient Follow-Up
- •15.4 Training Missions
- •15.4.1 Capacity Building
- •15.4.2 Training Method
- •References
- •17: Anatomy of the Inguinal Region
- •17.2 The Inguinal Canal (Fig. 17.7)
- •17.3 Entrance to the Channel: the Deep Inguinal Ring
- •17.5 Floor of the Channel: the Inguinal Ligament
- •17.8 Spermatic Cord and Vascular Issues
- •References
- •18: Ambulatory Hernia Surgery
- •18.2 History
- •18.4 International Comparison
- •References
- •Suggested Readings
- •20.1 Etiology
- •20.2 Clinical Manifestation
- •20.5 Treatment
- •20.5.5 Preoperative Preparation
- •20.5.7 Surgical Procedures
- •20.5.9 Surgical Procedures
- •References
- •21.2 Statistical Relevance
- •21.3 Pure Tissue Repairs
- •21.8.1 Foreign Object
- •21.9 Material-Related Changes
- •References
- •22.1 Introduction
- •22.2 Personal Experience
- •22.3 Indications
- •22.4 Surgical Technique
- •References
- •23: Bassini Repair
- •23.1 Introduction
- •23.3 Skin Incision
- •23.12 The Filzetta Stitch
- •23.13 The First Stitch
- •23.14 The Second Stitch
- •23.15 The Third Stitch
- •23.16 The Last Stitch
- •24: The Shouldice Repair
- •24.1 Introduction
- •24.2 Local Anaesthesia
- •24.3.1 Dissection
- •24.3.2 Reconstruction
- •24.4.1 Dissection
- •24.4.2 Reconstruction
- •References
- •25.1 Introduction
- •25.2 Surgical Indications
- •25.3 Surgical Technique
- •25.5 Outcomes
- •References
- •26.1 Indications
- •26.2 Patient Preparation
- •26.3 Original Technique
- •26.3.1 Anesthesia
- •26.3.2 Local Anesthesia
- •26.3.2.1 Mixture
- •26.3.3 Technique
- •26.4 Surgical Dissection
- •26.4.1 Hernia Sac Treatment
- •26.4.1.1 Medial Hernia Sac
- •26.4.1.2 Lateral Hernia Sac
- •26.4.2 The Mesh: Material
- •26.4.3 Mesh Fixation
- •References
- •27: Mesh Plug Repair
- •27.1 Introduction
- •27.2 Surgical Technique
- •27.3 Comments
- •References
- •28.1 Introduction
- •28.3 Surgical Procedure
- •28.3.1 Anesthesia
- •28.4.1 Antibiotic Prophylaxis
- •28.4.2 Preoperative Landmarks
- •28.4.3 Anesthesia
- •28.4.4 Nerve Management
- •28.4.5 Hernial Sac Management
- •28.4.6 Mesh Application
- •28.4.7 In Females
- •28.5 Discussion and Conclusions
- •References
- •29: Gilbert Technique: PHS Bilayer Repair
- •29.3 Suture Repairs
- •29.4 Anterior Mesh Repairs
- •29.9.4.1 Medial (Direct) Hernias
- •29.9.4.2 Lateral (Indirect) Hernias
- •29.9.7 Post-op Care
- •29.10 Results
- •29.13 Discussion
- •References
- •30.1 Introduction
- •30.2 The ONSTEP Technique
- •30.3 Clinical Data
- •30.5 Health Economics
- •30.6 Perspectives
- •References
- •31.1 Introduction
- •31.2 Anesthesia
- •31.3 Operative Technique: Lateral Hernia
- •31.3.1 First Step: Skin Incision
- •31.3.2 Second Step: Nerve Preservation
- •31.4 Operative Technique: Medial Hernia
- •31.6 Results
- •References
- •32: Minimal Open Preperitoneal (MOPP) Technique
- •32.1 Introduction
- •32.3 Surgical Technique
- •32.4 Indications
- •32.5 Special Cases
- •32.5.1 Female Hernias
- •32.5.2 Femoral Hernia
- •32.5.3 Scrotal Hernia
- •32.5.4 Strangulated Hernia
- •32.6 Contraindications
- •32.7 Personal Data
- •References
- •33.1 Introduction
- •33.2 Indications
- •33.3 Contraindications
- •33.4 Relative Contraindications
- •33.5 Preoperative Preparation
- •33.6 Operating Theatre Setup
- •33.6.1 Instruments
- •33.7 Surgical Technique
- •33.7.5 Hernia Reduction
- •33.7.5.1 Medial or Direct Hernia
- •33.7.5.2 Femoral Hernia
- •33.7.5.3 Obturator Hernia
- •33.7.5.4 Indirect Hernia
- •33.7.5.5 Mesh Repair
- •33.8 Postoperative Care
- •33.9 Complications
- •References
- •34: Primary Inguinal Hernia: TAPP
- •34.1 Introduction
- •34.3 The Standardized TAPP Technique
- •34.3.1 Pneumoperitoneum
- •34.3.2 Trocar Placement
- •34.3.3 Dissection
- •34.3.4 Mesh Placement
- •34.3.5 Fixation
- •34.3.6 Peritoneal Closure
- •34.3.8 Antibiotic and Thromboembolic Prophylaxes
- •References
- •35.1 Introduction
- •35.2 Biological Prosthesis
- •35.2.1 Features
- •35.4 Complications
- •35.5 Clean Fields
- •35.6 Contaminated Fields
- •35.7 Inguinal Sports Hernias
- •References
- •36: Inguinal Hernia Recurrence
- •36.1 Introduction
- •References
- •37.1 Introduction
- •37.2 Clinical Presentation
- •37.3 Literature Review
- •37.4 Surgical Technique
- •References
- •38: Pubic Inguinal Pain Syndrome (PIPS)
- •38.1 Introduction
- •38.2 Clinical Aspect
- •38.3 Diagnosis
- •38.4 Management
- •38.4.1 Conservative Treatment
- •38.4.2 Surgical Treatment
- •References
- •39.1.1 Incarcerated Hernia
- •39.1.2 Intestinal Occlusion
- •39.1.3 Strangulation
- •39.2 Diagnosis
- •39.2.1 Physical Examination
- •39.2.2 Ultrasound
- •39.2.3 Abdominal Radiographs
- •39.2.4 Computed Tomography
- •39.2.6 Laparoscopy
- •39.2.7 Deep Inguinal Ring Laparoscopy
- •39.3 Surgical Options
- •Bibliography
- •40.1 Watchful Waiting
- •40.2.1 Open Inguinal Hernia Repair
- •40.2.1.1 Mesh-Based Repair
- •40.2.1.2 Mesh Types
- •40.2.1.3 Lichtenstein Repair
- •40.2.1.6 Bilayered Mesh System
- •40.2.1.7 Self-Gripping Mesh
- •40.2.1.8 Glue Fixation
- •40.2.1.9 Preperitoneal Approaches
- •40.2.1.10 Suture-Based Open Repairs
- •40.2.2 Laparoscopic Inguinal Hernia Repair
- •40.2.3 Complications
- •40.2.3.1 Recurrence
- •40.2.3.2 Chronic Pain
- •40.2.3.4 Infections
- •40.2.3.5 Urinary Retention
- •40.2.3.6 Sexual Dysfunction
- •40.2.3.8 Seroma
- •References
- •41.2 Epidemiology
- •41.3.1 Neuropathic Pain Syndromes
- •41.3.1.1 Inguinal Nerve Involvement
- •41.3.1.2 Lower Intercostal Nerve
- •41.3.1.3 Neuroma Formation
- •41.3.2.1 Mesh-Related Pain
- •Meshoma Formation
- •41.3.2.2 Adductor Tendinopathy
- •41.3.2.3 Periostitis Pubis
- •41.3.2.4 Iliopectineal Bursitis
- •41.3.3 Combined Groin Pain Syndromes
- •41.3.3.1 Dysejaculation
- •41.4 Assessment
- •41.4.1 Patient’s History
- •41.4.1.3 Diagnostic Questionnaires
- •41.4.2 Physical Examination
- •41.4.2.4 Spine Examination
- •41.4.3 Pitfalls
- •41.4.4 Imaging
- •41.4.4.1 Ultrasonography
- •41.4.4.2 Computed Tomography
- •41.4.4.3 Magnetic Resonance Imaging
- •41.4.5 Other Diagnostics
- •41.4.5.1 Diagnostic Injections
- •Local Anaesthetic Agents
- •Corticosteroids
- •41.4.5.2 Quantitative Sensory Testing
- •41.4.5.3 Other Imaging Techniques
- •References
- •42.1 Clinical Assessment
- •42.2 Treatment
- •References
- •43.1 Surgical Techniques
- •43.1.1 Endoscopic Groin Exploration
- •43.1.2 Meshoma
- •43.1.3 Fixation
- •43.1.5 Orchialgia
- •43.1.6.1 Operative Technique
- •43.2 Results
- •References
- •References
- •45: Primary Femoral Hernia: Open Anterior Treatment
- •45.1 Introduction
- •45.4 Anaesthesia
- •45.5 Surgical Techniques
- •45.5.1 UHS: Ultrapro Hernia System
- •45.5.2 PHS: Prolene Hernia System
- •45.5.3 UPP: Ultrapro Plug
- •45.9.2 Anaesthesia
- •45.9.3 Local Complications n. 41 (16.8%)
- •45.9.4 Abdominal Complications
- •References
- •46.1 Introduction
- •46.1.2 Anesthesia
- •46.1.3 Surgical Techniques
- •46.1.3.1 The Kugel Approach
- •46.1.3.2 The Transinguinal Preperitoneal Technique (TIPP)
- •46.1.3.3 The Transrectus Sheath Preperitoneal Mesh Technique (TREPP)
- •46.1.3.4 Postoperative Recommendations
- •References
- •47: Laparoscopic Femoral Hernia Repair
- •47.5 Operative Technique
- •47.5.1 Total Extraperitoneal Repair (TEP)
- •References
- •48.1 Risk Factors
- •48.3 Surgical Technique Repair
- •48.4 Surgical Site Infection
- •48.5 Persisting Chronic Pain
- •References
- •49.1.1 Rectus Muscle
- •References
- •50: Umbilical Hernia Repair
- •50.1 Introduction
- •50.2 Open Repair
- •50.2.1 Tissue Repair
- •50.2.2 Mesh Repair
- •50.3 Minimally Invasive Repair
- •50.3.1 Laparoscopic Repair
- •50.3.2 Robotic Repair
- •References
- •51.1 Introduction
- •51.2 The MILOS Technique

Giampiero Campanelli Editor
The Art of
Hernia Surgery
A Step-by-Step Guide

The Art of Hernia Surgery

Giampiero Campanelli
Editor
The Art of Hernia Surgery
A Step-by-Step Guide

Editor
Giampiero Campanelli
University of Insubria, Istituto Clinico, Sant'Ambrogio General Surgery Day Surgery
Milan, Italy
ISBN 978-3-319-72624-3 ISBN 978-3-319-72626-7 (eBook)
https://doi.org/10.1007/978-3-319-72626-7
Library of Congress Control Number: 2018943734
© Springer International Publishing AG, part of Springer Nature 2018
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or
part of the material is concerned, specically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microlms or in any other physical way,
and transmission or information storage and retrieval, electronic adaptation, computer software,
or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specic statement, that such names are
exempt from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in
this book are believed to be true and accurate at the date of publication. Neither the publisher nor
the authors or the editors give a warranty, express or implied, with respect to the material
contained herein or for any errors or omissions that may have been made. The publisher remains
neutral with regard to jurisdictional claims in published maps and institutional afliations.
Printed on acid-free paper
This Springer imprint is published by the registered company Springer International Publishing
AG, part of Springer Nature.
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

Foreword
This new hernia book, The Art of Hernia Surgery: A Step-by-Step Guide,
edited by Professor Giampiero Campanelli, and which I have the honor and
the privilege to present, summarizes the maximum knowledge of abdominal
wall surgery at this time. It answers all the questions that surgeons, not just
hernia surgeons, will nd useful in their daily practice both for the benet of
their patients and for extending their own erudition.
As an esteemed hernia surgeon and as Secretary General of the European
Hernia Society (EHS) for more than 15 years, Professor Campanelli, with
whom I have collaborated for many years on the EHS Board, has seen
many changes and many advances and has rubbed shoulders with the
world’s top specialists in herniology. He appreciated the value of their
publications and for this reason chose these top specialists to write the 67
chapters of this book, which provide exhaustive information in the eld of
hernia surgery.
Although related to general and visceral surgery, surgery of the abdominal
wall is now a specialty in its own right. The names of the early pioneers in
modern hernia surgery and their books are well known, such as the publications of H. Fruchaud, L. Nyhus, B. Devlin, J.P. Chevrel or R. Bendavid,
V.K.Nigam, and C.Avci.
A number of important events have led to abdominal wall surgery becoming a recognized specialty. These events include the creation of the GREPA
Research Group on Wall Surgery in France by J.P. Chevrel in 1979, this
Group becoming the EHS in 1996. The following year, in 1997, an international journal, Hernia, was founded. Also notable are the creation of the
American Hernia Society in 1998 in Miami and the creation of the Asia
Pacic Hernia Society in 2004.
As well as these important societies, numerous other national hernia societies have been created, leading to a new surgical dynamic. Publication
requirements have gradually improved, with detailed statistical evaluations,
randomized trials, comparative studies, and so on. All of this activity has led
industry to develop, at our request, multiple kinds of prostheses (more than
250), both synthetic and biological, in various materials, textures, shapes, and
dimensions. We could also add the invention of many and varied means of
xation—sutures, staples, and glues. Other advances have led to such changes
as laparoscopic surgery, robotic surgery, and ambulatory surgery.
The content of the book is the result of all the scientic research, evaluation, and data generated by these societies through their publications.
v

vi
The originality of this book lies in its short and easy-to-read chapters, with
their complete descriptions of current methods and applicable references.
The book offers a broad range of subjects that are rarely tackled by other
hernia books. Among these topics, we can mention the problems of prevention and emergencies, the new total extraperitoneal repair technique, open
abdomen and component separation operations, and the Mini- or Less-open
Sublay Operation (MILOS) technique; also provided are hernia classica-
tions and guidelines.
In addition, you will nd an original presentation of the anatomy of the
abdominal wall, as well as detailed descriptions of traditional techniques in
the treatment of various types of hernias, including incisional hernias.
Improvements in these techniques and their recent results are also described.
In short, you will have everything to guide you in the decision-making
process.
In summary, it is a huge pleasure for me to introduce this new and complete practical hernia book, which is based on recent publications, clearly
presented, and enhanced with signicant illustrations.
I am sure that this book will be a reference for any surgeon, beginner or
senior, who is looking for information on recent methods and techniques in
hernia surgery.
I extend my congratulations to Professor Giampiero Campanelli and his
co-authors for this new hernia book, which is sure to become very
successful.
Foreword
Paris, France JeanHenriAlexandre

Preface
Over 100 years ago Edoardo Bassini, the great pride of Italian surgery, wrote
about whether it was still necessary to argue about hernia surgery.
Actually, from Hippocrates’ time until today, and certainly for decades to
come, we will continue to talk about hernia surgery and to discuss this topic.
In the last 30 years, during my succession of personal, academic, and,
especially, professional activities, I have had—for more than 15 years—the
honor of holding the leadership of the European Hernia Society. This organization has become a great Society, that, with the American Hernia Society,
the Asia Pacic Hernia Society, the Afro Middle East Hernia Society, and the
Australasian Hernia Society, involves the best international professionals in
the eld. The members of these Societies, I like to remember, are responsible
for the largest numbers of hernia surgeries carried out worldwide.
With the scientic expansion spearheaded by these Societies, technological and material evolution has been such as to arouse the interest of companies, patients, media, and, especially, surgeons.
The fundamental objective in surgery of the abdominal wall is that of a
restitutio adintegrum; that is, a reconstruction that is as natural as possible
and which can achieve a perfect repair in the different wall regions, with, at
the same time, a level of recurrences and complications that is as low as
possible.
But today this objective is not our only aim.
More important has become the concept of quality of life, which appears
in even the most serious and important series as an essential item whose measurement is requested by the individual patient after such surgery.
Essentially, postoperative comfort for the recovery of normal life and
work habits, and in some cases the improvement of sports performances, and
nally a natural appearance, have become collateral objectives that are
increasingly requested and form an essential part of our daily activity.
To this end, we have gradually developed a concept of tailor-made surgery,
which, together with the employment of our international guidelines, must
permeate the training and daily activity of surgeons who want to dedicate
their professional life to this exciting journey, which nowadays is recognized
as a super specialization, mostly realized at specic worldwide hernia centers, but also realized in general surgery departments, by general surgeons.
The precise concept behind this book is to give a real guide to expert herniologists and to general surgeons the world over, suggesting different
approaches, outlining technological aspects, and providing tips and tricks.
vii

viii
These contributions come from the wide experience of the authors—friends,
who, with me, share their passion and daily practices in the journey along this
complex, beautiful, and always developing path.
Milan, Italy GiampieroCampanelli
Preface

Contents
Part I General Aspects
1 History and Evolution of Hernia Surgery . . . . . . . . . . . . . . . . . . 3
Giampiero Campanelli, Piero Giovanni Bruni, Andrea
Morlacchi, Francesca Lombardo, and Marta Cavalli
2 Teaching Hernia Surgery: TheExperience of
theItalian School. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Paolo Negro, Linda D’Amore, Elena Annesi, Francesca Ceci,
and Francesco Gossetti
3 Alterations oftheExtracellular Matrix ofthe
Connective Tissue inInguinal Herniogenesis . . . . . . . . . . . . . . . 13
Gemma Pascual and Juan M. Bellón
4 Classification ofInguinal andAbdominal Wall Hernia . . . . . . 27
Diego Cuccurullo and Stefano Reggio
5 Diagnostic Tools inHernia Disease . . . . . . . . . . . . . . . . . . . . . . . 31
Paul Tenzel, Jordan Bilezikian, and William W. Hope
6 Materials, Devices andGadgets forHernia Surgery . . . . . . . . . 41
David L. Sanders, Kelly-Anne Ide, and Bassem Amr
7 Guidelines: Options andLimit . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Manuel López-Cano and Josep M. García-Alamino
8 Creation, Advantages, andLimits ofRegistries:
TheHerniamed Experience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
F. Köckerling
9 Management ofDatabase inHernia Surgery . . . . . . . . . . . . . . . 97
U. A. Dietz, S. Menzel, and A. Wiegering
10 Ventral Hernia Surgery inEurope: Trends and
Actual Situation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
S. G. Parker and A. C. J. Windsor
11 Hernia Repair intheUnited States:
Current Situation andTrends . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
James G. Bittner IV and Natasha L. Clingempeel
ix

x
12 Hernia Surgery inAsia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Davide Lomanto
13 Hernia Surgery inAustralasia . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Andrew Bowker
14 Hernia Surgery inAfrica . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
F. Abi, M. Aboulalaa, M. Mehhane, M. Moumen, F. El Farès,
J. Obama, M. El Akkad, M. J. Moosa, M. M. Noori,
and D. Maggiore
15 Humanitarian Hernia Surgery: Lessons Learned . . . . . . . . . . . 139
Alexander D. Schroeder and Charles J. Filipi
16 The Most Important Clinical Trial intheLast 10 Years
inInguinal andIncisional Hernia Surgery . . . . . . . . . . . . . . . . . 153
Lars Nannestad Jorgensen and Thue Bisgaard
Part II Inguinal
17 Anatomy oftheInguinal Region . . . . . . . . . . . . . . . . . . . . . . . . . 159
J. Loriau
18 Ambulatory Hernia Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
R. Lorenz
Contents
19 Obscure Groin Pain inWomen . . . . . . . . . . . . . . . . . . . . . . . . . . 183
Shirin Towgh
20 Individualization Treatment of
Inguinal Hernia inChildren . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Jie Chen, Yingmo Shen, Chengbing Chu, Zhenyu Zou,
and Xin Yuan
21 Indications forPure Tissue Repairs . . . . . . . . . . . . . . . . . . . . . . 199
A. Koch, R. Bendavid, J. Morrisson, C. Hill, K. Petersen, and
V. Iakovlev
22 Local Anesthesia inInguinal Hernia: Indications
andTechniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
Giampiero Campanelli, Piero Giovanni Bruni, Francesca
Lombardo, and Marta Cavalli
23 Bassini Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225
Enrico Nicolò
24 The Shouldice Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239
Paolo Bocchi
25 Primary Inguinal Hernia: Sutureless Open Anterior,
Trabucco Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245
Giampiero Campanelli, Piero Giovanni Bruni, Andrea
Morlacchi, Francesca Lombardo, and Marta Cavalli
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