**5. Conclusion**

This led to the setting of guidelines for prevention and treatment of this situation [31].

No restriction 227 246 250 Slight restriction 23 4 0 Severe restriction 0 0 0

implantation.

**Table 5.** Restriction in daily activities.

56 Hernia Surgery and Recent Developments

rate of recurrence.

the upper third.

If we consider the areas of weakness within the inguinal canal from which the three types of hernia arise, we see an oval-shaped surface surrounded by known muscular and fascial structures on the canal's floor and a further weak zone in proximity to the deep inguinal ring (**Figure 2**). The transversalis fascia is an important restraining element for both structure and functionality in a region lacking overlying muscular structures. Then, the idea of a prosthesis specifically shaped to obtain containment by acting directly on the weak areas of the transversalis fascia without involving muscular or nervous structures avoiding to place a subaponeurotic mesh. This allows the procedure more anatomical with minimal foreign body

**First week n. pt Second week n. pt Third week n. pt**

The prosthesis size, defined after numerous measurements of the inguinal canal made at the operating table, is notably smaller than the ones used as of now, allowing a precise and

The weak areas along the transversalis fascia are strengthened, all at once, by the prosthesis

Polypropylene was chosen because of its capacity of inducing a lively inflammatory and fibrotic response with quick and strong adhesion to adjacent tissues. A prompt fibroblastic reaction between transversalis fascia and mesh immediately takes place because of the

This new technique is simple to perform and guarantees quick discharge and return to normal activities without any long-term discomfort. The average operative time was 25 min. The surgeon needs not dissect the cremaster, which may cause damage to the nerves, nor create a

Furthermore, no plugs nor mesh trimming are necessary, and the prosthesis does not have to be sutured to adjacent structures. The use of a smaller quantity of prosthetic material allows the envelopment of the mesh by the fibro-cremasteric sheath, avoiding contact with surrounding nerves. Because of its shape, the mesh is placed in a deeper site directly over the weak areas of the floor of the inguinal, canal and, although smaller, it seems not to increase

The most common technique of Lichtenstein provides a prosthesis which, to remain on the transversalis fascia, must be fixed to the sides and becomes necessarily under aponeurotic in

smooth positioning in a different plane to where the nerves lie.

absence of any dead space and quickly forms a new wall.

subfascial "nest," because no mesh is inserted at that level.

(all-in-one mesh), so that losing a hernia sac can no longer happen [2].

This new procedure claims many technical advantages and helps the less experienced surgeon to avoid pitfalls in dealing with nerves. According to our series, "all-in-one mesh" hernioplasty presents a low rate of long-term complications. Employing a smaller amount of prosthetic material, placed where no contact with nerves occurs, avoids neuralgia and sensation of foreign body.

A multicenter study is underway to compare this new procedure with the most common techniques.
