MUSCHAWECK MINIMAL TENSION REPAIR TECHNIQUE
This is a suture only technique that does not use a mesh. This is preferred by athletes since their tissue quality is usually very good above and below the area of weakness.
The procedure begins by making a 7-8cm incision in the lower abdomen above the inguinal ligament. A very bloodless and meticulous dissection is carried out to limit trauma to the tissues. The inguinal canal is opened, and immediately the ilioinguinal nerve is identified and carefully dissected free with minimal handling of the nerve. The iliohypogastric nerve is then carefully identified and preserved. These two nerves are responsible for sensation in the lower abdomen, and do not require removal in normal circumstances.
Next, the area of weakness on the inguinal floor is isolated, then it is then carefully opened to identify the conjoint tendon and the shelving edge of the inguinal ligament. It is critical to identify these structures so that the strong tendon and ligament can be brought together with as little tension as possible. A multi-layer permanent suture repair is used to reconstruct the inguinal floor. By bringing the conjoint tendon of the abdominal wall down to the shelving edge of the inguinal ligament, the body is reconstructed to its original anatomic configuration.
The genital branch of the genitofemoral nerve is identified and transected to remove it as a source of pain. This nerve merely provides sensation to the inguinal floor, pubic bone, and on occasion some skin along the upper inner thigh. This nerve does not innervate the genitals in either the male or female patient, and removal of this one nerve will not affect sexual function or sensation.
The structures are then placed back in the inguinal canal, and the layers of tissue brought back to their original configuration to leave the operative site as anatomic as it was found.