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Can Relaxing Rectus Sheath Incision Predispose to Recurrent Direct Inguinal Hernia?

Arch Surg. 1981;116(11):1493. doi:10.1001/archsurg.1981.01380230107016.
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To the Editor.–In the April 1981 issue of the Archives (116:440-445), Drs Read and McLeod describe elegantly the "Influence of a Relaxing Incision on Suture Tension in Bassini's and McVay's Repairs." I have consistently lacked faith in Cooper's ligament repair precisely because while it seems structurally sound, it causes mechanical violence to the integrity of the repair. To me, the tension is visibly and palpably greater than in Bassini's or Shouldice's herniorrhaphy. The verifying suture tension measurements now reported provide a significant contribution.

However, even the relaxing incision is not necessarily a safe maneuver. In 1970, I first reported a clinical observation,1 which has a direct bearing on the subject. I quote in its entirety the "Discussion and Summary" section taken from a follow-up article in 19722:

Myocoele, or true muscle hernia, was defined by Schechter [Hernia (Philadelphia, JB Lippincott Co, 1964), pp 797-804] as "an extrusion


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