Mesh Placement in Stoppa Repair for Inguinal Hernia
In the Stoppa (Rives-Stoppa) repair for inguinal hernia, the mesh is placed in the preperitoneal space (retromuscular plane), posterior to the transversalis fascia and rectus muscles, without fixation or with minimal fixation, as it is held in place by intra-abdominal pressure.
Anatomical Position and Technique
The Stoppa approach utilizes a preperitoneal mesh placement that covers the myopectineal orifice from behind 1. The key technical principles include:
The mesh is positioned below the transversalis fascia in the preperitoneal space, creating a barrier between the peritoneum and the abdominal wall defect 1
The prosthesis is fitted around the spermatic cord and extends laterally to cover all potential hernia sites in the groin 1
Minimal or no fixation is typically required, as positive intra-abdominal pressure keeps the mesh in position 1
Fixation Strategy (When Used)
When fixation is employed in the Stoppa technique, it is minimal:
A single stitch to the pubic tubercle may be used for initial positioning 1
A few resorbable sutures to the posterior face of the transversalis fascia can provide additional stability 1
The mesh placement in the retromuscular/preperitoneal plane allows the intra-abdominal pressure to naturally hold the prosthesis against the abdominal wall, eliminating the need for extensive fixation 1
Anatomical Reconstruction
After mesh placement, the technique involves:
Closure of the posterior sheath over the mesh when possible 2
Tension-free closure of the anterior musculo-aponeurotic layer, reconstructing the midline and restoring anatomical integrity 2
This layered reconstruction helps restore both anatomical and physiological properties of the abdominal wall 2
Clinical Outcomes
The retromuscular mesh placement in Stoppa repair has demonstrated: