A 58-year-old man has massive bilateral direct inguinal hernias with poor attenuated transversalis fascia and two previous failed mesh repairs. Which operation was designed specifically for this situation, using a large unsplit prosthesis placed preperitoneally to reinforce the entire visceral sac bilaterally?
- A Stoppa giant prosthetic reinforcement of the visceral sac (GPRVS) ✓
- B Lichtenstein tension-free repair
- C Shouldice four-layer repair
- D Desarda darning repair
Correct answer: A. Stoppa giant prosthetic reinforcement of the visceral sac (GPRVS)
Explanation
Stoppa's GPRVS places a large uncut polyester prosthesis wrapping around the peritoneal sac in the preperitoneal space, usually via a lower midline extraperitoneal approach, so intra-abdominal pressure holds the mesh against the pelvic walls without sutures. It is reserved for complex, recurrent, or bilateral hernias with destroyed tissue unsuitable for standard repairs. Lichtenstein, Shouldice and Desarda all work through the inguinal canal and depend on usable local tissue, which this patient lacks.
Reference: Sabiston Textbook of Surgery, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.