In solving
inguinal hernias, surgeons today have in front of them many variations of different operative procedures (both tensional and non-tensional techniques). They are performed through operative or
endoscope approach. Classical tension techniques present the operation of choice for smaller indirect, direct or
femoral hernias among younger patients while non/tensional techniques are the best
solution for all types of
inguinal hernia among older patients with big destruction of transversal fascia and the best
solution for most of recurrent
hernias. Positioning of mesh with non-tensional techniques can be completed on different levels, with big
hernias where the biggest part of transversal fascia of miopectineal orifitium is destroyed it is anatomically the most useful to place the mesh in preperitoneal space. Rives technique is the base of that concept and it presents one of good solutions in that kind of situations. In the period January 2001 until december 2002 using different operative techniques the authors treated 99
inguinal hernias of which 78 were primary and 21 recurrent
hernias. Rives technique was performed in 46 cases (46.5%) among which 26 cases were primary inguinoscrotal
hernias (3 patients IIIA, 22 patients IIIB, 1 patient IIIC, according to Nyhus classification) and 20 cases were recurrent
hernias (6 patients IVA, 11 IVB, 3 IVD). Complications after Rives technique were the following: 1 recurrence (2.17%), 1 ischemic
orchitis (2.17%) and 1 scrotal
hematoma (2.17%).
Infections and
chronic pain were not present. The follow up was from 30 days to 2 years. Authors have shown that Rives technique is reliable
solution for primary indirect, direct and
femoral hernias with big hernial defect (especially for big, so called "giant" inquinoscrotal
hernias) and for all types of recurrent
hernias. The advantage of the technique is an easy performance without some previous special training because of the fact that dissection and preparation is the same as for the tension techniques. With small amount of prosthetic material all weak points of miopectineal orifitium are closed. The real risks of this technique are ischemic
orchitis and chronis
neuralgia in treatment of recurrent
hernias and the presence of
polypropylene mesh in Bogras space.