What is the Bassini repair for inguinal hernia?

Bassini Repair for Inguinal Hernia

The Bassini repair is a historical tissue-based technique for inguinal hernia repair that has largely been superseded by tension-free mesh repairs, which offer significantly lower recurrence rates and better outcomes. 1

What is the Bassini Repair?

The Bassini repair is a traditional tissue-based technique for inguinal hernia repair that involves:

• Division of the transversalis fascia to mobilize the triple layer (transversalis fascia, transversus abdominis, and internal oblique muscles) 2
• Suturing this triple layer to the pubic tubercle and inguinal ligament with separated stitches 2
• Creating a reinforced posterior wall of the inguinal canal using the patient's own tissues without mesh 3

Current Status in Modern Hernia Surgery

• Mesh-based repairs are now strongly recommended as the standard approach for non-complicated inguinal hernias according to current guidelines 4, 5
• The Bassini technique has been associated with significantly higher recurrence rates (11.1%) compared to tension-free mesh repairs (0%) in controlled studies 6
• Patients undergoing Bassini repair experience:
  • Longer hospital stays (8.2 ± 2.0 days vs. 4.3 ± 2.7 days for mesh repair) 7
  • Higher analgesic requirements 7
  • Longer recovery times 1

Limitations of Bassini Repair

• Higher recurrence rates compared to mesh-based techniques 6, 7, 1
• Increased tissue tension leading to more postoperative pain 7
• Longer recovery time and hospital stay 7
• Does not address the metabolic origin of inguinal hernias 1

Current Recommended Approaches

• Mesh repair is strongly recommended as the standard approach for all non-complicated inguinal hernias 4, 5
• Laparoscopic approaches (TAPP or TEP) offer advantages including:
  • Reduced postoperative pain 4, 5
  • Lower wound infection rates 4
  • Faster return to normal activities 5
  • Ability to identify and repair occult contralateral hernias (present in 11.2-50% of cases) 4

Special Considerations

• For strangulated hernias requiring emergency repair, mesh can still be safely used in clean surgical fields 4, 5
• Even in cases of intestinal strangulation without gross enteric spillage, prosthetic repair with synthetic mesh is recommended 4
• For small defects (<3 cm) with bowel necrosis or peritonitis, primary tissue repair may be considered 4

Common Pitfalls to Avoid

• Using outdated tissue-based repairs like Bassini when mesh repairs offer superior outcomes 1
• Delaying repair of strangulated hernias, which can lead to bowel necrosis and increased morbidity/mortality 5
• Overlooking contralateral hernias, which can be avoided by considering a laparoscopic approach 4, 5