How is the incision made in the Lichtenstein tension-free mesh repair for open inguinal hernia 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 incision is placed about 1 cm above and parallel to the inguinal ligament, beginning from the pubic tubercle and extending 5-6 cm laterally up to the midinguinal point (see the images below). The subcutaneous fat is then opened along the length of the incision, and careful hemostasis is achieved by ligating superficial pudendal and superficial epigastric vessels.

Open inguinal hernia repair. Draping and incision. Open inguinal hernia repair. Draping and incision.
Open inguinal hernia repair. Skin incision. Open inguinal hernia repair. Skin incision.

The Scarpa fascia is similarly opened along the length of the incision, down to the external oblique aponeurosis, and the external inguinal ring and the lower border of the inguinal ligament are visualized (see the images below). Below the inguinal ligament, on the medial aspect, the deep fascia of the thigh is opened, the femoral canal exposed, and a check made for any concomitant femoral hernia. Although the risk is very low, routine exploration of the femoral canal is advised in the absence of an inguinal hernia and in women. [5]

Open inguinal hernia repair. External oblique apon Open inguinal hernia repair. External oblique aponeurosis with external inguinal ring.
Open inguinal hernia repair. External oblique apon Open inguinal hernia repair. External oblique aponeurosis with external inguinal ring.

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