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Stoppa's procedure for large inguinal hernia
Nowadays meshes are used in groin hernia surgery because the results are better then without a mesh.
If there is a bilateral large hernia that cannot be treated by a laparoscopic procedure it is still possible to place a mesh in the preperitoneal space by means of a median incision. This technique is described by Stoppa.
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In this case of a bilateral hernia the left hernia is filled by a loop of the colon (1,2).
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In this supine position the hernias do not seem very big, but this is quite different when the patient is standing. The skin is opened with the electric knife (hardly any bloodloss). After opening of the subcutis the fascia is opened and the muscle kept aside. Then the preperitoneal plane is reached (3-5).
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The hernia is freed, mostly blunt, from its surroundings and retracted and pushed back in the abdomen. Sometimes it is necessary to enlarge the opening of the hernia to make the reposition possible (6,7). In 8 a part of the hernial sac can be seen.
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When the reposition is completed and enough space is created the mesh(es) are introduced and positioned. Then the fascia is closed with a resorbable running suture and the skin with staples.