How is the Muschaweck repair different?
Anthony Echo, MD
There are several different types of non-mesh repair techniques for sports hernias or inguinal hernias. The technique that I perform routinely is the Muschaweck minimal tension repair technique, which is a modification of the Shouldice Repair technique originally from Canada. The modification is in regards to the area of repair necessary on the inguinal floor.
I was fortunate to have the opportunity to work with Dr. Ulrike Muschaweck several years ago to learn her technique and bring it back to the United States. The major benefit of the Muschaweck technique when compared to the others, is that it truly reconstructs the inguinal defect in the correct anatomical position.
Often in athletes, core muscles are very well developed; however, these structures may have developed an area of weakness either from chronic overuse or an abrupt injury. Regardless of injury pattern type, the conjoint tendon and the inguinal ligament are often normal in character surrounding the area of weakness. By bypassing this area of weakness and bringing the conjoint tendon on the lower border of the internal oblique and the transversalis muscles back down to the shelving edge on the inguinal ligament, your muscles are reattached to their original location.
Also, by not overtightening the muscle, like some other techniques, there is less pain and a quicker return to recovery is possible, which was demonstrated in a study comparing this technique versus another commonly used technique in the United States.
Another unique aspect of the technique is that the genital branch of the genitofemoral nerve is transected and allowed to retract back into the abdominal cavity. While this nerve is called the genital branch, it does not provide sensation to the genitals, so removing it will not affect sexual sensation. By removing this nerve branch, pain on the inguinal floor and pubic bone is often minimized post-operatively, with only minimal numbness on the skin around the incision.
The other two nerves in the area, the ilioinguinal nerve and the iliohypograstric nerves are carefully dissected and persevered to maintain sensation in the groin crease and lower abdomen. Every step is performed with the utmost precision to limit bleeding and excessive handling of the tissues to decrease scar tissue formation.
Outcomes can vary depending on the extend and duration of the individual’s injuries. And as with any surgical repair, recurrent injuries can occur. However, it is critical to have a skilled surgeon perform this surgery at the start to best improve your chance of a successful surgery and recovery.