Why to choose our technique
Our technique differs from the others because - respects the anatomy, and avoid the use of prostheses except in cases where it is necessary - It is physiological, respects the function of the inguinal canal and the musculature is preserved without placing full-thickness stitches in the muscles - Unlike many other anatomical techniques, sutures are tension free in our method while we recognize in other so called prosthetic "tension free" techniques numerous defects
Fig 1. Respect the other anatomical techniques the Guarnieri's technique do not fix any muscle (like the Bassini's technique for inguinal hernia repair). Stitches are never placed full-thickness to not immobilize the musculature and preserve the physiology.
Fig 2. The hernia laxity (A) is used to perform a double breast suture that doubles the layer reinforcing it (B).
Fig 2. The prosthesis can be placed to further reinforce the layer over the muscle (immobilizing it - C) or under it (D). It is better to avoid direct contact of the prosthesis with the bowel (laparoscopy - case D). The prosthesis can be placed between the two hernia sac flaps (Guarnieri 1988) so that the mesh can be covered and protected.
Fig 3.
The problem of suture tension can be seen in the picture (letter B) where a
suture that approximate the margins of an hernia opening is under tension. This
is the problem of the so called old anathomical techniques like the Bassini's
technique.The modern anathomical techniques (Guarnieri's and Shouldice's techniques) double layers (letter C).
Prostheses can be placed over or under the muscles (letters C and D of the previous picture Fig. 2) to reinforce the layer.
Fig 4.
It is a mistake to put the prosthesis over the muscles leaving a false no tension (see letter B). The laxity give no tension under rest, but this is not true under stress. The abdominal pressure push on it reflecting the so called Laplace law of physics.