Background: A new technique to strengthen the posterior wall of the inguinal canal in all types of inguinal hernias is described. This method of repair is done without mesh and has been developed because mesh is not easily available in rural or remote parts of many countries.
Methods: After excision of the sac, a strip of the external oblique aponeurosis (EOA) is partially separated from its medial leaf, keeping its continuity intact at either end. This undetached strip of EOA is sutured to the inguinal ligament below and the arch of muscle above, behind the cord, to form a new posterior wall. This strip is put under tension by muscular contraction and works as a shield to prevent recurrence so that the external oblique muscle gives additional strength to the weakened internal oblique and transverse abdominis muscles.
Results: A total of 400 patients have been operated on from 1983 to 1999 and follow up by physical examination was carried out. (Eighty patients have been followed up for more than 10 years.) The postoperative period was comfortable with a hospital stay of 2–3 days and a return to work within 1–2 weeks. Recurrence was seen in only one case and haematocoele in one case.
Conclusion: These results are comparable with operations performed with mesh. This operation is simple to perform, does not require mesh or extensive dissection and has produced excellent results. Therefore it is a good alternative to mesh or other open or laparoscopic repairs.