How is the inguinal canal exposed in the 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 external oblique aponeurosis is then opened along the line of incision, starting from the external ring and extending laterally for up to 5 cm (see the image below). The ilioinguinal nerve, lying underneath the aponeurosis, is safeguarded during this procedure.

Open inguinal hernia repair. Division of external Open inguinal hernia repair. Division of external oblique aponeurosis.

The superior and inferior flaps of the external oblique aponeurosis are gently freed from the underlying contents of the inguinal canal and overturned and separated to expose the cremaster with the cord structures, the ilioinguinal and iliohypogastric nerves, the uppermost aponeurotic portion of the internal oblique muscle and conjoined tendon, and the free lower border of the inguinal ligament (see the images below). Wide separation of the two flaps provides ample space for placement and fixation of mesh under vision while protecting the nerves.

Open inguinal hernia repair. Reflected part of ing Open inguinal hernia repair. Reflected part of inguinal ligament exposed for fixing inferior edge of mesh.
Open inguinal hernia repair. Inferior flap of exte Open inguinal hernia repair. Inferior flap of external oblique aponeurosis developed to expose inguinal ligament from pubic tubercle to midinguinal point.
Open inguinal hernia repair. Superior flap of exte Open inguinal hernia repair. Superior flap of external oblique aponeurosis is developed as high as possible to provide ample space for mesh placement.

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