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Adult inguinal hernia: pathophysiology and repair.

An anatomic and physiologic rationale is presented for the correction of inguinal hernias utilizing a simplified anterior approach, which opens and overlaps the transversalis-transversus abdominis posterior wall. The absence of tension is vital. It permits an uninterrupted repair of the direct and indirect components without additional reinforcement. A prospective randomized study is currently in progress comparing this two-layer technique to the author's three-layer modified Shouldice operation. Three-hundred and twenty-six repairs have been followed for at least 20 months with a mean follow-up time of 29 months. There have been two recurrences in each group. A better evaluation will be available when 1000 operations have been collected with a mean follow-up time of 46 months.