Stitches no, stitches yes-Mr. Rossi and the inguinal hernia

I do not have accurate and up-to-date statistical data, but off the top of my head I would say that the most widely used technique in Italy foringuinal hernia surgery is the Trabucco technique.

Ermanno Trabucco, a Neapolitan surgeon who moved to New York early in his career, was one of the pillars of abdominal wall surgery in the 20th century; and his technique, developed in the 1980s, represents one of the milestones in the history of inguinal hernia repair.

The principle on which it is based is simple and - like all simple things - ingenious: if you have to use a net to repair the hernia, and if you put this net in an enclosed, virtual space, then it is impossible for it to move: therefore, it is useless to put stitches to fix it - which solves at least some of the problems related to the infamous "post hernioplasty inguinodynia," a terrible term for the postoperative inguinal pain that, not so rarely, remains in patients. In fact, this pain is due, at least in part, to the phenomenon of "nerve entrapment": sometimes, some of the often almost invisible sensory nerve sprigs located in the inguinal region are "trapped" by the stitches that are affixed to fix the mesh; this causes the onset of pain, varying in intensity and duration but not infrequently chronic and excruciating.

Trabucco called this space the "inguinal box," described it accurately in his papers and proved the validity of his idea with the results of his daily clinical work.

And, indeed, Trabucco's technique is simple, standardized, easily reproducible and easy to teach. It is, in fact, the classic "ideal" surgical technique, which admits of no argument, no interpretation, no error. It is almost a profession of faith (scientific faith, of course).

A great many Italian surgeons claim to use Trabucco's technique in their surgeries. But-will this really be the case?

In fact, if you talk to them, someone says, "Mah... I put a stitch on the tubercle... you know, just in case..." - "Mah... I leave the cord under the band, it looks more natural to me...." I don't want to go into technical details, boring for most, however... nice, beautiful, typical of much Italian surgery: we do things because "it seems to us," "just in case," not because there is the slightest scientific basis.

AND, MOST IMPORTANTLY, IT'S NOT TREBUCHET'S TECHNIQUE. Call it "Mr. Rossi's technique," folks, and let the Great Surgeons rest in peace.