Internal Reconstruction of the Pelvic Floor for Recurrent Groin Hernia

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Abstract
Repeated recurrence of groin hernia is more than an anatomical derangement that any trained surgeon can correct. Attempts to improve results include application of local patches of Marlex. There are two reasons (one theoretical and one practical) why a local synthetic patch may not be as useful as total reconstruction of endopelvic fascia with a biologically active, as well as structurally strong, living material. Such a restoration can be accomplished with the entire fascia lata from one thigh utilized as a free graft extending from one pelvic wall to the other and from the symphysis to the pubic rami. The practical advantage of a single sheet of fascia extending across the pelvic floor (like an airplane wing) is that frequent medial recurrences are eliminated because there is no medial edge under which peritoneum can protrude. The theoretical advantage of a biologically active graft is based upon animal data revealing the inductive capacity of fascia in stimulating net collagen synthesis and deposition. Thirteen patients with multiple recurrences following conventional repair of groin hernia have been reconstructed with large fascia lata grafts restoring the entire endopelvic floor. Over a 5-year period no recurrences have been detected. A technique for removing the entire fascia lata from one thigh through a single transverse incision will be shown. There have not been any donor site complications and there is no disability caused by removing the fascia.