Bassini Repair Surgical Technique for Inguinal Hernia
The Bassini repair is a historical tissue-based technique for inguinal hernia repair that has largely been superseded by mesh-based repairs, which offer significantly lower recurrence rates.
Description of the Bassini Technique
- The Bassini repair involves suturing three anatomical layers (transversalis fascia, transversus abdominis and internal oblique muscles) to the inguinal ligament 1
- A key element of the technique is the division of the transversalis fascia to achieve better mobilization of the triple layer, allowing it to approach the inguinal ligament without tension 1
- The repair is completed by suturing this mobilized layer to the pubic tubercle and inguinal ligament with separated stitches 1
Limitations of the Bassini Technique
- Bassini repair has significantly higher recurrence rates (21%) compared to modern mesh-based repairs (6%) 2
- Patients undergoing Bassini repair experience higher postoperative pain scores, require more analgesics, and have longer convalescence time compared to laparoscopic approaches 2
- The technique has been largely replaced by tension-free mesh repairs due to unacceptable recurrence rates and prolonged postoperative pain and recovery time 3
Current Recommendations for Inguinal Hernia Repair
- Prosthetic repair with synthetic mesh is now the recommended standard approach for inguinal hernia repair due to lower recurrence rates compared to tissue-based repairs like Bassini 4, 3
- Mesh repair is superior to pure tissue approximation repairs according to level A evidence from randomized comparative studies 3
- Even in cases of intestinal incarceration without signs of strangulation, mesh repair is recommended over tissue-based techniques 5
- For emergency repair of strangulated inguinal hernias, Lichtenstein "tension-free" technique has been shown to be safe and effective with low postoperative complications and without recurrence, compared to Bassini repair which had an 11.1% recurrence rate 6
Modern Alternatives to Bassini Repair
- Laparoscopic approaches (TAPP and TEP) offer advantages including reduced postoperative pain, lower wound infection rates, and faster return to normal activities 7
- Laparoscopic repair allows assessment of the contralateral side to identify occult hernias, which are present in 11.2-50% of cases 4, 7
- Local anesthesia can be used for emergency inguinal hernia repair in the absence of bowel gangrene, providing effective anesthesia with fewer postoperative complications 5
Special Considerations
- For small defects (<3 cm) with bowel necrosis or peritonitis, primary repair may still be considered 4
- When direct suture is not feasible in contaminated fields, a biological mesh may be used, with the choice between cross-linked and non-cross-linked biological mesh depending on defect size and degree of contamination 4
- In unstable patients with severe sepsis or septic shock, open management is recommended to prevent abdominal compartment syndrome 4
While the Bassini repair was historically significant in the evolution of hernia surgery, current evidence strongly supports the use of mesh-based repairs due to their superior outcomes in terms of recurrence rates, postoperative pain, and recovery time.