In the Stoppa technique for giant inguinal hernia repair, a large prosthetic mesh is placed in the retropubic space of Retzius. Which mechanism of mesh fixation provides the primary long-term tension-free stability in this approach?

• A Suture fixation to Cooper's ligament bilaterally
• B Fibrin glue fixation to the posterior abdominal wall
• C Tack fixation at the symphysis pubis
• D Intraperitoneal pressure physiologically stabilizing the mesh against the myopectineal orifice ✓

Explanation

The Stoppa (giant prosthetic reinforcement of the visceral sac/GPRVS) technique exploits Pascal's law: intraperitoneal pressure acts uniformly on the mesh positioned posterior to the peritoneum and anterior to the abdominal wall, holding the mesh in place against the myopectineal orifice without requiring suture or tack fixation. The greater the intraperitoneal pressure, the more firmly the mesh is held. This 'umbrella' effect eliminates the need for suturing, reducing nerve entrapment risk. Cooper's ligament fixation is used in open preperitoneal repairs but is not the primary mechanism in the Stoppa technique.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.