I have a small to midcsize indirect inguinal hernia. I read Dr Brown’s comments that he recommends a marcy with possible desarda reinforcement. So I’ve been reading about the marcy repair which seems it is rarely used in adults. There is also a lot of study’s stating there is no advantage to ligating the hernia sac versus just pushing it back into the abdominal cavity. But I can’t find anything saying what ligation means…so what is that? Cutting it off? And if you are cutting into a hernia sac is that mean your cutting into the intestines?
The “sac” is the stretched out fascia and peritoneum. It can contain intestine, or fat, or omentum. The contents of the sac can be pushed back in to the abdominal cavity before the sac is ligated. Meaning tied off, so that the “stuff” can’t get back in to it.
Don’t get drawn in to trying to translate comments about mesh repairs to pure tissue repairs. That’s one reason mesh is popular. It removes the need for things like ligation. With mesh the surgeon can just push everything back in to the abdominal cavity, plop the piece of mesh over the defect and all potential future defect sites, with lots of overlap in to areas that had no problems so that the defect will still be covered when/if the mesh moves and/or shrinks.
Mesh is designed to be quick, easy, “anybody can do it”, get-’em-in-get-’em-out. Pure tissue repair requires a higher skill level and more advanced knowledge of anatomy. I think that that is one reason surgeons don’t like to talk about mesh repairs. A surgeon can take pride in learning how to do a good pure tissue repair. With mesh, they usually talk about how fast they can get it done.
Regardless of technique: lap, open, mesh, non-mesh, the hernia sac and its contents must be reduced. Traditionally with open surgery, the redundant portion of the sac is ligated. Dr Amid suggested the act of ligation (cut and tie) of the hernia sac (peritoneum) is unnecessary and may contribute to pain after hernia repair. In laparoscopy we almost never ligate. We just reduce the sac.
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