From the Research
The Lichtenstein tension-free mesh hernioplasty is a surgical procedure for repairing inguinal hernias, and the key steps include making a 5-6 cm incision, dissecting through the subcutaneous tissue, opening the external oblique aponeurosis, identifying and isolating the spermatic cord, reducing the hernia sac, placing a piece of polypropylene mesh, securing the mesh with non-absorbable sutures, and closing the skin incision with subcuticular sutures, as described in the study by 1. The steps of the Lichtenstein tension-free mesh hernioplasty can be summarized as follows:
- Make a 5-6 cm incision in the inguinal region, parallel to the inguinal ligament
- Dissect through the subcutaneous tissue and Scarpa's fascia to expose the external oblique aponeurosis
- Open the external oblique aponeurosis to reveal the inguinal canal and its contents
- Identify and isolate the spermatic cord, separating it from the hernia sac
- For indirect hernias, dissect and reduce the hernia sac, and for direct hernias, reduce the protruding tissue
- Place a piece of polypropylene mesh (typically 7x15 cm) over the posterior wall of the inguinal canal, covering the entire myopectineal orifice
- Secure the mesh with non-absorbable sutures: to the pubic tubercle medially, along the inguinal ligament inferiorly, and to the internal oblique muscle superiorly
- Create a slit in the lateral part of the mesh for the spermatic cord to pass through
- Close the external oblique aponeurosis over the mesh and spermatic cord using absorbable sutures
- Close the skin incision with subcuticular sutures This technique provides a tension-free repair by reinforcing the posterior wall of the inguinal canal with mesh, reducing the risk of recurrence, as supported by the study by 2, which reported a low recurrence rate of 0.2%. The use of a self-adhesive mesh, as described in the study by 3, can also be considered, as it has been shown to reduce operating times and costs, and has a low incidence of chronic pain. It is also important to note that the key principles of the Lichtenstein tension-free hernioplasty, as described in the study by 1, include using a large sheet of mesh, crossing the tails of the mesh behind the spermatic cord, securing the mesh with interrupted and continuous sutures, positioning the mesh in a slightly relaxed dome shape configuration, and identifying and protecting the ilioinguinal, iliohypogastric, and genital nerves throughout the operation. Overall, the Lichtenstein tension-free mesh hernioplasty is a safe and effective procedure for repairing inguinal hernias, with a low risk of recurrence and complications, as supported by the studies by 1, 2, and 3.