[Musculo-aponeurotic flap in the treatment of inguinal hernias, apropos of 1,600 operations].

Morbidity, absention and duration of cares are important factors for the treatment of groin hernias. Deep and tension free cure is a key element to decrease the rate of recurrence. Utilization of prosthesis cannot provide a rate of 100%. This must be taken into consideration for indications. Beside we must take into account specific risks of each technique. Hernia treatment cannot be unique. This parietal surgery must remain a technique with low morbidity. As for treatment of unilateral hernia, we have qualified a technique of hernioplastia depending upon theses criteria, by inguinal incision, without prosthesis. Our technique includes: A complete dissection of the inguinal canal. The resection of the sac of the hernia at the internal ring. A deep cure of the fascia transversalis. A systematic incision of discharge on the anterior face of the rectus sheath. This incision is extremely internal and constitutes a large musculo-aponeurotic flap of 8 to 12 cm that makes this cure tension free possible. In the term of 10 years, our recurrence rate is below 1% for type I or II hernias in Nyhus classification. Consequently we discuss the indications for prosthesis. They must be reserved for hernias with high recurrence risk, bilateral hernias of for recurrent hernias.