From the Guidelines
The recurrence rate of the Lichtenstein hernia repair technique is very low, typically ranging from 0.5% to 2%. This technique, which involves placing a mesh over the hernia defect in the inguinal region, has become the gold standard for open inguinal hernia repair due to its effectiveness and low recurrence rates 1. The mesh creates a tension-free repair by reinforcing the weakened area rather than pulling tissues together under tension. Factors that may influence recurrence include surgical technique, mesh type and placement, patient factors such as obesity or smoking, and post-operative activities.
Proper surgical technique with adequate mesh overlap (at least 2-3 cm beyond the defect edges) is crucial for minimizing recurrence. Patients should follow post-operative instructions including activity restrictions for 4-6 weeks to allow proper healing and mesh integration. The low recurrence rate of the Lichtenstein technique is attributed to the tension-free nature of the repair and the body's incorporation of the mesh into the surrounding tissues, creating a strong, permanent reinforcement of the hernia defect. A recent prospective study included 202 patients with acutely incarcerated groin hernias, and the results showed extremely low rates of wound infection, mesh infections, and recurrence, concluding that the use of mesh in incarcerated hernias is safe 1.
Some key points to consider in minimizing recurrence rates include:
- Adequate mesh size and placement
- Proper surgical technique
- Patient factors such as obesity or smoking
- Post-operative activities and restrictions
- The use of mesh in clean and contaminated fields has been shown to be safe and effective in reducing recurrence rates 1.
Overall, the Lichtenstein hernia repair technique has been shown to be a highly effective and safe method for repairing inguinal hernias, with low recurrence rates and minimal complications, as demonstrated by multiple studies 1.
From the Research
Recurrence Rate of Lichtenstein Hernia Repair
- The recurrence rate of Lichtenstein hernia repair has been reported to be low in several studies, ranging from 0.2% to 2.7% 2, 3.
- A study published in 2001 reported a recurrence rate of 0.2% in 540 patients who underwent Lichtenstein tension-free mesh inguinal hernia repair 2.
- Another study published in 2018 reported a recurrence rate of 2.7% in 78,230 patients who underwent Lichtenstein repair, compared to 1.5% in 1229 patients who underwent Prolene Hernia System repair 3.
- A study published in 2007 reported a recurrence rate of 1.1% in 300 patients who underwent open mesh repair of primary inguinal hernia using a modified Lichtenstein technique 4.
- A study published in 2003 reported a recurrence rate of 0.7% in 142 patients who underwent Lichtenstein hernioplasty 5.
- A randomized, multicenter trial published in 2009 reported a cumulative recurrence rate of 1.2% in 705 patients who underwent Lichtenstein repair, compared to 3.5% in 665 patients who underwent totally extraperitoneal patch (TEP) repair 6.
Factors Affecting Recurrence Rate
- Surgical experience and technique have been identified as factors that can affect the recurrence rate of Lichtenstein hernia repair 4, 6.
- The use of prosthetic materials, such as polypropylene mesh, has been associated with lower recurrence rates 2.
- The type of hernia, such as direct or indirect, may also affect the recurrence rate 3.