What is a Lichtenstein tension-free mesh repair?

Updated: Jan 17, 2018
  • Author: Vinay Kumar Kapoor, MBBS, MS, FRCS, FAMS; Chief Editor: Kurt E Roberts, MD  more...
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Answer

The Lichtenstein tension-free mesh repair, which is an example of hernioplasty and is currently one of the most popular open inguinal hernia repair techniques, includes the following components:

  • Opening of the subcutaneous fat along the line of the incision
  • Opening of the Scarpa fascia down to the external oblique aponeurosis and visualization of the external inguinal ring and the lower border of the inguinal ligament
  • Opening of the deep fascia of the thigh and exposure of the femoral canal to check for a femoral hernia
  • Division of the external oblique aponeurosis from the external ring laterally for up to 5 cm, safeguarding the ilioinguinal nerve
  • Mobilization of the superior (safeguarding the iliohypogastric nerve) and inferior flaps of the external oblique aponeurosis to expose the underlying structures
  • Mobilization of the spermatic cord, along with the cremaster, including the ilioinguinal nerve, the genitofemoral nerve, and the spermatic vessels; all of these structures may then be encircled in a Penrose drain or tape
  • Opening of the coverings of the spermatic cord and identification and isolation of the hernia sac
  • Inversion, division, resection, or ligation of the sac, as indicated
  • Placement and fixation of mesh to the edges of the defect or weakness in the posterior wall of the inguinal canal to create a new artificial internal ring, with care taken to allow some laxity to compensate for increased intra-abdominal pressure when the patient stands
  • Resection of any nerves that are injured or of doubtful integrity
  • In males, gentle pulling of the testes back down to their normal scrotal position
  • Closure of spermatic cord layers, the external oblique aponeurosis, subcutaneous tissue, and the skin

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