It was reported via journal article: "title: simultaneous adenomectomy and preperitoneal repair of inguinal hernias by a single incision with the application of polypropylene mesh".Authors: i.Filiadis, k.Hastazeris, i.Tsimaris, a.Papadopoulos, s.Kakoulidis, n.E.Stavropoulos2.Citation: international urology and nephrology.2003; 35: 19¿24.Preperitoneal inguinal herniorraphy in conjuction with other pelvic procedures has been described in the literature, but it has not gained wide popularity mainly due to the high recurrence rate.The authors evaluated the results and complications of 22 patients who underwent open surgical prostatectomy (adenomectomy) and simultaneous preperitoneal application of polypropylene mesh.Of which, 19 patients suffered from unilateral inguinal hernia, located on either the left or right side and 3 patients had bilateral inguinal hernias.During the surgical procedure, a two-dimensional (2d) prolene polypropylene non-absorbable mesh (ethicon) was applied onto the defect.The mesh was applied in such a manner so as to cover the entire myopectineal orifice with attention paid to avoiding both extreme tension and folding of the mesh.For bilateral repairs, 2 meshes were applied.Excess of mesh was discarded by cutting it with scissors.Excessive suturing for mesh immobilization was avoided.Therefore, a few interrupted sutures of vicryl 2-0 (ethicon), taking care to have at least 6.5 mm of the mesh extended beyond the suture line, were applied.Two stay sutures of vicryl 2-0 (ethicon) were placed in order to immobilize the side of the mesh closer to the midline of the body on the linea alba or oblique muscles.Reported complications included wound infection and cutaneous fistula (n-1) in which the event of infection was managed conservatively by surgical debridement of the incision, intravenous administration of broad spectrum antibiotics, and regular application of antibiotic solution at the incision and the event of cutaneous fistula was managed by attentive surgical care and recurrence of protrusion of the indirect type (n-1) and does not need further surgery.The authors experience indicates that intraoperative timing of the inguinal repair during transvesical adenomectomy is of utmost importance.The authors strongly suggest that the dissection of the hernial sac should be performed before removal of the adenomatous tissue but repair should be done after the closure of the bladder wall.The mesh application should be the last endopelvic ¿manipulation¿ just before closure of the abdominal wall, as other authors have also suggested.Since complications attributable to preperitoneal hernioplasty are rare, the repair of clinically apparent inguinal hernias should be safely considered as a concomitant procedure in candidates for benign prostatic adenomectomy.
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