Hernia repairs performed between January 1999 and December 2006 were included in the study. The European Hernia Society recommends that in cases where an open approach is indicated, the Lichtenstein technique be utilized as the preferred method. Nowobilski W, Dobosz M, Wojciechowicz T, Mionskowska L. Lichtenstein inguinal hernioplasty using butyl-2-cyanoacrylate versus sutures. Close the external oblique aponeurosis with a continuous suture (Vicryl 2-0). Jorgensen LN, Hope WW, Bisgaard T. Risk Factors for . Hernia sac management in … 2015 Jun;19(3):355-66. If not already available as ready-made Lichtenstein mesh, cut out a 8 x 14 cm mesh with a lateral slit and tapered tails. Pisanu A, Podda M, Saba A, Porceddu G, Uccheddu A. Meta-analysis and review of prospective randomized trials comparing laparoscopic and Lichtenstein techniques in recurrent inguinal hernia repair. Köckerling F, Schug-Pass C. Tailored approach in inguinal hernia repair – decision tree based on the guidelines. Paajanen H. A single-surgeon randomized trial comparing three composite meshes on chronic pain after Lichtenstein hernia repair in local anesthesia. To fix the small repair, Lichtenstein invented the technique of “plugging” the defect with a small piece of rolled mesh. Sparing the structures of the spermatic cord, free the hernia sac down to the hernia defect in the transversalis fascia. Ann Surg . Hernia 2002; 6: 99-101. The technique with the Lichtenstein Plug since1989 has allowed to obtain a lower rate of complications and recurrences as well as an early recovery of the patients usual activities. Early results of a single-blinded, randomized, controlled, Internet-based multicenter trial comparing Prolene and Vypro II mesh in Lichtenstein hernioplasty. Primary inguinal hernia in patients > 30 years, except for small lateral hernias, No other contraindications since the procedure can be performed under local anesthetics, Digital rectal examination in men > 50 years, Marking the side of the hernia examined with the patient standing, 1/2 hour before skin incision a single-shot antibiotic regimen is recommended, e.g., with 2, Chronic groin pain such as ilioinguinal syndrome. Lightweight mesh should be used in open (Lichtenstein) inguinal hernia repair. Hernia 2004; 8: 127-34. Eur J Surg 1999; 165: 49-53. Surgery of hernia according to the Lichtenstein method. In this procedure, repair is accomplished by covering the opening of the hernia with a patch of mesh, instead of sewing the edge of the hole together The particular nerves at danger are: lateral femoral cutaneous; ilioinguinal; iliohypogastric; genital and femoral branches of the genitofemoral nerve. Splay open the hernia sac and reduce its contents. This may result in total loss of the testicle. Douglas JM, Young WN, Jones DB. In case of any bleeding you can easily pull up the stump with the stay sutures and institute the necessary hemostatic measures. Lightweight mesh is recommended in open inguinal (Lichtenstein) hernia repair: A systematic review and meta-analysis Surgery. At the deep inguinal ring place the superior tail of mesh over the inferior tail. Bracale U, Melillo P, Pignata G, Di Salvo E, Rovani M, Merola G, Pecchia L. Which is the best laparoscopic approach for inguinal hernia repair: TEP or TAPP? The number of recurrences has been reduced to … Close the base of the hernia sac with an outer purse string suture and remove the excess. Registration number: NCT00803985 ( www.clinicaltrials.gov). There you can adjust your cookie settings at any time afterwards. The hernia repair approaches in the present study consisted of primary hernia repair methods (Bassini, Mcvay),, Lichtenstein technique,, mesh-plug technique, transabdominal preperitoneal approach (TAPP), and total extraperitoneal (TEP) repair. 4. Iatrogenic injury to the vein with subsequent thrombosis in the surgical field must be regarded as deep venous thrombosis of the pelvis. Lichtenstein open tension-free mesh hernioplasty is suitable for all adult patients, irrespective of age, weight, general health, and the presence of concomitant medical problems. Design: Prospective, randomised, trial. Treatment of deep venous thrombosis of the lower extremity Compression, ambulation, full heparinization (Caution: Risk of secondary bleeding!). In my practice, the tension-free Lichtenstein technique is only applied on large (>3 cm) hernia or in case of weak connective tissue as frequently seen in the elderly. Webop uses cookies to enable you to visit the website securely and conveniently. In this example, the defect is a direct hernia because the hernia sac has developed medial to the epigastric vessels. Aufenacker TJ, van Geldere D, van Mesdag T, Bossers AN, Dekker B, Scheijde E, van Nieuwenhuizen R, Hiemstra E, Maduro JH, Juttmann JW, Hofstede D, van der Linden CT, Gouma DJ, Simons MP. Now longitudinally divide the fibers of the external oblique, including the superficial inguinal ring. Lichtenstein method was performed to repair inguinal hernia . Strangulation was defined by failure of manual reduction of an inguinal hernia. The Lichtenstein hernia repair is indicated for initial mild to moderate, direct or indirect inguinal as well as femoral hernias in both men and women. More common; men > women; congenital (patent processus vaginalis) or acquired (also via the deep inguinal ring in the lateral inguinal fossa, mostly in adults); hernia sac passes lateral to the epigastric vessels into the scrotum and labia majora respectively. The Lichtenstein tension-free mesh repair, which is an example of hernioplasty and is currently one of the most popular open inguinal hernia repair … Subcutaneous suture, continuous intracutaneous absorbable skin suture. After the operation a sand bag may be placed on the wound for a few hours; remove any Redon drain on postoperative day 1 or 2. In femoral hernias the lacuna vasorum is the deep weak spot (through the femoral septum along the femoral vein). . Diagnostic work-up: Duplex and doppler ultrasonogrpahy or phlebography. With some interrupted (absorbable) sutures anchor the superior part of the mesh on the internal oblique. Surgery 1998; 123: 121-6. 2012 Dec;26(12):3355-66. It is important not leave any gaps along the inguinal ligament since this heightens the risk of recurrence. 17(14):1791-6. . Data was recorded prospectively and each TEP repair was matched with a LR for analysis. Mills IW, McDermott IM, Ratliff DA. All invested by the internal spermatic fascia, cremasteric fascia, and external spermatic fascia. La chirurgie n'est désormais plus conseillée dans la plupart des cas, depuis que la survei… This also applies to those rare cases where the seroma results in an infection. The "tension-free" mesh technique was pioneered by the Lichtenstein Hernia Institute in 1984 and is currently considered the gold standard of hernia repair by the American College of Surgeons. Br J Surg 2006; 93: 1056-9. (Figure 1) The black spot represents the hernia opening in the muscular wall of the abdomen. Prospective randomized comparison of the Shouldice and Lichtenstein hernia repair procedures. 2. In the standard Lichtenstein Repair, this mesh is placed between the layers of the abdominal wall. Open mesh inguinal hernia repair: Inguinal hernia repair either with the bilayer mesh or the Lichtenstein technique. Vatansev C, Belviranli M, Aksoy F, Tuncer S, Sahin M, Karahan O. If the size of the seroma results in clinical symptoms, in rare cases this may require paracentesis (absolutely sterile conditions!). Hernia is a tear, or hole, in the musculature of the abdominal wall (Figure 1). Lichtenstein technique. 2014 Jun;399(5):553-8. doi:10.1007/s00423-014-1212-8. Less foreign body sensation in the groin (↑ [5; 19]), Trend of less chronic groin pain (↑ [5; 19]), No significant differences in the perioperative course (↑↑ [1; 4; 17]), After mesh fixation by sealant perhaps somewhat less postoperative pain (↑ [9; 10; 16]), With staples and tacks somewhat shorter operating time (↑ [7; 14]), Comparable recurrence rates overall (↑ [7; 9; 10; 14; 16]), Evidently no reduction in the rate of wound infection (↑ 2). Hernia 2004; 8: 28-32. 2020 Mar;167(3):581-589. doi: 10.1016/j.surg.2019.08.021. Treatment: Small postoperative seromas are absorbed by the tissue and only require follow-up. Hidalgo M, Castillo MJ, Eymar JL, Hidalgo A. Lichtenstein inguinal hernioplasty: sutures versus glue. The parallel lines represent normal muscle fibers. Definition: Irreversible epithelial injury of the seminiferous tubules with subsequent loss of spermatogenesis. La chirurgie de la hernie inguinale est l'opération chirurgicale pour la correction d'une hernie inguinale. This link will take you to the International Guideline Library. In direct hernia the hernia sac usually does not have to opened. Introduction. Clinical symptoms: Initially swelling and warming, followed later on by shrinking and dyesthesia. With this type of surgery, only a small repair is needed while the rest of the repair remains intact. 4Many different tension-free techniques have been developed, 4–8and the use of mesh is common and increasing. However, postoperative discomfort still constitutes a concern and an area for improvement. 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