Although statistical data may suggest that one method of hernia repair is better than other, no single method can be declared successful without complications. With time many techniques have come forward to produce better results. The present study was done at General hospital Solapur between March1998 and March 2001, to evaluate the status of Mairs repair in patients with relatively large hernias in whom a prolene mesh repair was not feasible due to economic constraints and where routine herniorrhaphy would not be an ideal solution.

The study is a prospective, non-comparative study. 50 patients above 20 years of age (Table 1) were included in the study. All the patients were male patients. Both direct (n=6) and indirect (n=44) hernias were included. No other major surgery like prostatectomy, laparotomy were done simultaneously. Patients had moderate to large size inguinal hernia and 29 patients had associated Malgagnies bulging’s. The commonest co morbid condition was smoking (n=17) (Table 2).

All co morbid factors, which could hamper a successful repair, were initially corrected. It was made sure that patients did not have any groin infection.

All patients were operated under spinal or general anaesthesia, as deemed fit by the anaesthetist. In only one patient it was necessary to operate under local anaesthesia as the patient had severe cardiac lesion.

The type of hernia repair to be done is best decided by the operating surgeon, considering his personal experience with the aim of obtaining a sound repair, which is cost effective, safe, simple, less painful without the likelihood of facing the disaster of recurrence.

A sound hernia repair should incorporate the following.1-3

In a meta-analysis by Voyles et al compared the complication rates, hospital stay, cost and the success rates. They found that Laparoscopic hernia repair was associated with earlier return to work compared to conventional open hernia repair but the conventional open hernia repair provides an equivalent outcome but at a lower cost with potentially less severe complications. The analysis suggests that open preperitoneal placement of mesh still has place in management of inguinal hernias.4

Although monofilament polypropylene mesh is an ideal prosthesis, it has problems in the Indian setup. It proves costly for the average Indian patient, sometimes the cost of the repair is approximately equal to his entire monthly wage and may afford it. Hence in this study we decided to study the role of Mairs repair for inguinal hernia in the Indian poor socioeconomic scenario. Mairs repair uses the autogenous full thickness skin graft for the reinforcement of the posterior wall. The sebaceous glands and the hair follicles do not survive longer than 12 weeks, though some sweat glands and the ducts survive permanently. No evidence showed that they contribute to cyst formation. Cysts have been found to occur in dermal grafts when epidermis is not completely removed.5,6

Mairs repair is a cost effective alternative to the polypropylene mesh for use in lower socioeconomic strata.

It provides a repair that is superior to a conventional herniorrhaphy and gives an equally good result when compared to other hernioplasty.

Further dermal grafts are better tolerated by the host tissue being an inert autologous material and shows stability in the presence of infection. The auto graft physically strengthens the defect in the transversalis fascia by supplying fibroblasts, collagen and also lays down matrix upon which collagen synthesis takes place. It is non allergic, easy to handle, does not require sterilization and has good pliability and strength.

Thus it has all the qualities of a good prosthesis. The repair does not require extra skills nor does it compromise cosmesis, and the defense mechanism of the inguinal canal is also maintained.

The salient features of the revisited technique are:

Thus Mairs repair is a very acceptable and a feasible method of hernia repair and can be recommended as an alternative primary technique for large inguinal hernias, especially where the patients should not be refused the advantage of a tensionless hernioplasty only because they cannot afford a polypropylene mesh.