The Gridiron Hernioplasty

Abstract

Some techniques in surgery are derived from those of other professions; placing a piece of material between two layers as reinforcement and stiffening is a technique well known to engineers, carpenters, dressmakers, wallpaper hangers, and many others, who call it “laminating.” Thinking about how to perform the unilateral Stoppa and Wantz operation with an open, minimally invasive approach instead of the total extraperitoneal laparoscopic approach, the author remembers his grandmother. She repaired a worn jacket by removing one or two stitches in the armhole seam and then inserting between it and the lining a piece of cloth rolled around a pair of sticks. With the two sticks the “mesh” was then unfurled and positioned. It is often said that the treatment of hernia must be as simple as possible. Modifying the instruments and using a 2.5 to 3 cm gridiron incision, the author used the same technique to reinforce the weakened layer of the abdominal wall in the treatment of groin hernias. The mesh is rolled up and inserted in the prepared space with forceps and spread out with long, thin specula or retractors. The technique has been used in over 500 operations in our department.