Grau-Talens EJ, et al. - In this study, researchers reported a prospective study of repairs using the Rives technique of the more difficult primary inguinal hernias, focusing on the immediate post-operative period, clinical recurrence, testicular atrophy, and chronic pain. They realized the cruciality of understanding inguinal preperitoneal space anatomy for The Rives technique. The technique seemed an excellent option for the larger and difficult primary inguinal hernias, giving a low rate of recurrences and chronic pain.

Methods

• Researchers favoured preperitoneal placement of a mesh, covering the myopectineal orifice by means of a transinguinal (Rives technique) approach for the larger primary inguinal hernias (Types 3, 4, 6, and some 7).
• They performed the Rives technique on 943 patients (1000 repairs), preferably under local anaesthesia plus sedation in ambulatory surgery.

Results

• For the procedure, the mean operative time was 31.8 min.
• After 24 h, pain assessment with an Andersen scale and a categorical scale gave two patients with intense pain on the Andersen scale, and four patients who thought their state was bad.
• Researchers observed surgical wound complications in ≤ 1%; urinary retention was observed in 1.2% mostly associated with spinal anaesthesia and, in one case, bladder perforation was encountered.
• Spermatic cord and testicular oedema with some degree of orchitis were encountered in 17 patients.
• In this study, the clinical follow-up of 849 repairs (86.4%), mean (range) 30.0 (12–192) months, gave five recurrences (0.6%), three cases (0.4%) of testicular atrophy, and 37 (4.3%) of post-operative chronic pain (8 patients with visual analogue scale of 3–10).