Convencional approach with mesh. In emergency setting I employ an open preperitoneal approach with mesh even in cases where an intestinal resection is necessary.
Elective: Preperitoneal approach. Asthenic -suture; Hypersthenic- mesh; Sthenic- either with or without a mesh ( A mesh is a foreign body-- although I have seen hundreds of stainless steel wire mesh used for inguinal hernia repair by Preston and Richards in the 1950's to 1970.s and eventually published in the Surgical Clinics of North America, circa that date. I have seen deformations, perforations, recurrences, and adhesions from such nonbiologic foreign materials.)
Emergency - Inspect the viability of the incarcerated organ.
Now - convencional approach with or without mesh.
Years ago I used Mc'Vay method - now disused, and conventional preperitoneal Nihus repair - now also disused.
May be in future - laparoscopic preperitoneal approach with mesh.
= After many cadaver anatomical dissections, in my opinion, McVay is still the most anatomical approach to any inguinal herniorrhaphy, however, in his classical description he misidentified the femoral sheath.
A mesh plug (not a patch) with a flared proximal base can also be custom tailored for size, deployed. then sutured to the femoral ring carefully avoiding untoward femoral vein compression that can occur. .
Agre with Francisco Tirol. Perhaps Rudgio Parlovequio (a Variation of McVay that sutures the Common Tendon, with rectal sheet aleviation, to the Cooper ligment is intresting. Always taking care of the femoral vein.
I am not clear about the question" Hernia Crural".Is it meant for Diaphragmatic hernia ?
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