Inguinal hernia in Saudi Arabia. A 10 year experience.

There are differing opinions regarding the cause of inguinal hernias in adults. It seems that a patent vaginal process may determine the type of herniation that occurs in an adult but may not actually cause the hernia. Also, altered collagen metabolism seems to play a significant role in many cases of hernias in adults. Thus, most of these hernias are actually caused by a mixture of congenital and acquired factors. Consequently, it follows that there are a variety of opinions regarding surgical repair. This follow-up study on recurrence after inguinal hernia repair in Saudi Arabia was aimed at testing the effectiveness of Bassini's repair and the results achieved when it is employed for primary inguinal hernia repair in adults. One hundred forty patients (95 with indirect and 45 with direct hernias) who had Bassini's repair were studied. Only pure direct or indirect hernias were included. Combined direct, indirect bilateral, recurrent, or femoral hernias were not investigated. All the patients were followed for 2 years after repair, with a total recurrence rate of 2.14 percent. The projected recurrence rate at 25 years is 5.3 percent. These results are comparable to those achieved with other techniques. Therefore, I believe that the criticisms of Bassini's repair are based on theoretic grounds only. Bassini's repair has stood the test of time, is easier to teach and to perform by junior surgeons, and the chance of being complicated by thrombophlebitis and pulmonary embolism is less than the chance with Cooper's ligament repair.