How should the mesh be fixed to the medial inguinal (Poupart) ligament?

I apologize, but the evidence provided does not address your specific question about mesh fixation to the medial inguinal (Poupart) ligament.

The available evidence focuses primarily on:

• Emergency hernia repair in contaminated fields 1
• General mesh placement techniques 2, 3, 4
• Laparoscopic fixation methods 5, 6
• Myopectineal reconstruction 7

What the Evidence Does Show

The limited relevant information suggests:

For open inguinal hernia repair, the mesh should be secured to the inguinal ligament (Poupart's ligament) with appropriate laxity, not under tension 3. One historical study noted that disruption of the mesh from the "shelving margin of Poupart's ligament" occurred when patches were too narrow and under tension, emphasizing the need for adequate mesh width and tension-free fixation 3.

For modified Rives technique, mesh is anchored 2-3 cm from all edges including the inferior border (which would be near Poupart's ligament), though specific fixation details to the ligament itself are not provided 2.

Critical Gap

None of the provided guidelines or high-quality studies specifically address:

• The optimal fixation method (suture vs. tack vs. glue) to Poupart's ligament medially
• The number of fixation points needed
• The specific anatomical landmarks for medial fixation
• Whether fixation should be continuous or interrupted

To properly answer your question, I would need evidence specifically addressing mesh fixation techniques to the medial aspect of the inguinal ligament in standard inguinal hernia repair.