Surgery- lichtenstein hernioplasty

1. Lichtenstein hernioplasty
Presented by - Roll no . – 19005

2. Introduction -
• Lichtenstein tension free mesh hernioplasty is used for the
management of inguinal hernia .
• In this procedure the posterior wall is strengthened by a prolene
mesh .
• The fibroblast and capillaries grows over the mesh , converting it
into thick fibrous sheath and strengthening the posterior wall .

3. • In this procedure polypropylene mesh is used .
• 8×16 cm mesh is tailored to patient requirement.
• Preparation of mesh – corners can be cut so as to give round
shape . A slit is given on the lateral border of the mesh at the
junction of lower one – third and upper two – third , to allow
spermatic cord to pass through .
• Suturing – medially the mesh overlaps the pubic tubercle and
is sutured over the tissue of symphysis . Laterally , the two tails
are placed beyond deep ring and sutured . Inferiorly , it is
sutured to inguinal and lacunar ligament and superiorly to
conjoint tendon

4. Advantages of polypropylene mesh
• High tensile strength .
• Biocompatible , non – absorbable
• Monofilament strong , elastic and transparent mesh
• Ideal porosity or high visibility and colonisation .
• Strong mechanical reinforcement .
• Encourages rapid ingrowth of connective tissue .
• Cheaper
• Flexible for any anatomical placement .
• Advantage of light weight and large pores mesh –
Less shrinkage of mesh , more flexible , better tissue
integration , better comfort

5. Characteristics of ideal mesh -
• Biocompatibility means it should not do any harm , should
be chemically and physically inert .
• Risk of infection should not be there .
• Handling should be good .
• Economical
• Longevity

6. Steps -
• Inguinal incision is made by cutting skin and superficial fascia .
• The external oblique aponeurosis is incised .
• Superficial ring is incised being careful not to injure ilioinguinal nerve
• The cord structures are dissected , and a sling is placed .
• Once the deep ring is reached a glistening white structure or hernial
sac is visible .
• Sac is dissected out , incised and opened with artery forceps .
• The contents of the sac are pushed back
• The sac is twisted , transfixed and excess sac is removed by cutting it .
• Than a mesh is used . It needs to be big enough to accommodate the
cord structures and for shrinkage .

7. • The first bite to fix the mesh is taken close to the pubic tubercle
and not through the pubic tubercle [ causes chronic inguinal
pain ]
• The mesh is placed around the cord structures by making sure
not to entrap the iliohypogastric nerve .
• Mesh is secured behind the cord structures as well .
• The sling is removed .
• External oblique aponeurosis is closed and a new superficial ring
is made .
• Subcutaneous layer and skin incised is closed