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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_1433_Библиотеки_им_академика_М_И_Перельмана.pdf
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G. Campanelli (Ed), Inguinal Hernia Surgery,
Updates in Surgery
DOI: 10.1007/978-88-470-3947-6_2, © Springer-Verlag Italia 2017
G. Campanelli ()
of Abdominal Wall and Surgical Treatment and Repair of Abdominal Hernia, Istituto Clinico
Sant’Ambrogio
Milan, Italy
e-mail: giampiero.campanelli@grupposandonato.it
2
Tension-free, Sutureless Primary Inguinal
Hernia Repair: the Trabucco Technique
Giampiero Campanelli, Piero Giovanni Bruni, Andrea Morlacchi,
and Marta Cavalli
2.1 Introduction and Technical Background
Ermanno E. Trabucco (August 15, 1926 - March 9, 2015) in 1988 (Fig. 2.1) [1, 2,
from one individual to another: it measures around 12 cm from the anterosuperior
iliac spine to the pubic tubercle, 7 cm from the anterosuperior iliac spine to the
deep inguinal ring, 5 cm from the internal inguinal ring to the pubic tubercle, and
(Fig. 2.3) [1, 2, 4]. In order for a sutureless preshaped mesh to be effective, it must
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G. Campanelli et al.
of the spermatic cord. This opening is located 6 cm from the tip and 4 cm from
the base of the mesh.
Fig. 2.1 Ermanno E. Trabucco (August
15, 1926 - March 9, 2015)
Fig. 2.2
[1, 2]
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2 Tension-free, Sutureless Primary Inguinal Hernia Repair: the Trabucco Technique
for the formation of dead spaces and recurrences [6, 7]. Soft meshes cannot be
sutures are applied.
into place.
intra-abdominal pressure is evenly distributed over a large surface area of mesh:
dead space.
Such a mesh is time saving and easy to implant. The postoperative discomfort
of the inguinal region is of crucial importance to reduce the rate of neuralgia in
the short and long term [8].
nerves and respect them during the repair (Figs. 2.4 and 2.5). The intentional
the prosthesis to prevent scar tissue involving the spared nerves, ensure a further
Fig. 2.3 Trabucco universal preshaped mesh
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G. Campanelli et al.
The ideal polypropylene prosthesis for a tension-free primary inguinal hernia
repair according to Trabucco must be as much as possible adapted to the patient
overall physical performance, personal daily needs and, of course, the type of hernia
Fig. 2.4
iliohypogastric and ilioinguinal nerves
Fig. 2.5
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2 Tension-free, Sutureless Primary Inguinal Hernia Repair: the Trabucco Technique
The Hertra Herniamesh preshaped prosthesis (n. 1-6, from the most rigid to the
Trabucco technique can be easily performed as a day case, under local
routinely in all simple primary inguinal hernias [3].
pulmonary and cardiac status.
2.2 Surgical Technique
oblique aponeurosis (Fig. 2.7) is incised longitudinally. The cremaster muscle is
drain encircles the mesentery and spermatic cord.
crus from the cribriform fascia (Fig. 2.8). This dissection lengthens the crus, thus
sutures, if necessary.
After adequate dissection of the subfascial space, a small quantity of local
near the deep inguinal ring so as to lift the fascia from the preperitoneum and
under the fascia around the spermatic cord: its correct position must be visually
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G. Campanelli et al.
and positioned around the spermatic cord in the preperitoneal space (Fig. 2.11).
has contained the hernia sac. The same plug can be used alone in small indirect
indirect recurrences.
Fig. 2.6 Local anaesthesia before the inguinal incision, at the beginning of the procedure
Fig. 2.7
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2 Tension-free, Sutureless Primary Inguinal Hernia Repair: the Trabucco Technique
The medial end of the preshaped prosthesis is placed onto the dissected pubic
tubercle and held in this position by an instrument. The mesh is placed on the
oblique muscle (Figs. 2.12 and 2.13).
Fig. 2.8
E.E. Trabucco) [1, 2]
Fig. 2.9
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G. Campanelli et al.
is closed behind the spermatic cord. Shifting a T4 plug lateral to the deep inguinal
inguinal rings and preserves the obliquity of the inguinal canal. For instance, in
Fig. 2.10
Trabucco
Fig. 2.11
large internal inguinal ring,
anchored to the preshaped
onlay mesh (original
E.E. Trabucco) [1, 2]
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2 Tension-free, Sutureless Primary Inguinal Hernia Repair: the Trabucco Technique
the hole of the preshaped prosthesis 1 cm medial to the deep inguinal ring, and
overlaps the pubic tubercle by 1 cm [2].
Fig. 2.12
E.E. Trabucco) [1, 2]
Fig. 2.13 Intra-
of a polypropylene
preshaped mesh
implanted in the
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G. Campanelli et al.
cord, and the procedure is complete (Figs. 2.14 and 2.15).
Fig. 2.14 Closure of
aponeurosis, under the
spermatic cord (original
E.E. Trabucco) [1, 2]
Fig. 2.15
superimposed on the anterior
supplied by E.E. Trabucco) [1, 2]