Modified Lichtenstein Procedure for Repair of Direct or Indirect Inguinal Hernia by Triangulation of the Inguinal Canal
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Hellenic Journal of Surgery (2018) 90:5, 239-241
Modified Lichtenstein Procedure for Repair of Direct or Indirect Inguinal Hernia by Triangulation of the Inguinal Canal Yücesoy AN
Abstract A modified Lichtenstein hernioplasty procedure was performed, by triangulating the inguinal canal, for indirect or direct inguinal hernia. A series of 276 patients is reported, who underwent a modified Lichtenstein procedure for surgical repair of the indirect or direct inguinal hernia, 32 of which were recurrent hernias. Because of the presence of bilateral hernia in 28 of the cases, the total number of modified Lichtenstein procedures performed was 304. The Lichtenstein hernioplasty procedure was modified by placement of the polypropylene mesh between the Poupart's ligament and the intersection line of the aponeuroses of the external oblique and internal oblique abdominal muscles. The main aim of this modification is to provide stabilization of the inguinal canal. Postoperative pain, and hematoma or seroma formation were very rare in the postoperative period. No recurrence was observed. Based on these results, a modified Lichtenstein hernioplasty procedure with inguinal canal triangulation should be considered for surgical stabilization of the inguinal canal, especially in the case of recurrent hernia. Key words: Inguinal hernia; Lichtenstein procedure; postoperative pain; recurrence
Introduction
Matherials and Methods
Inguinal hernia repair is the one of the most commonly performed elective surgical procedures. The term ''hernia'' is derived from the ancient Greek (kele/hernios) meaning bud [1]. Inguinal hernias constitute approximately 75% of all abdominal wall hernias [2]. Indirect inguinal, direct inguinal and femoral hernias are the most common types of hernia in the inguinal region. While femoral hernia shows significant female pre dominance, indirect and direct inguinal hernias are mostly seen in males [2]. Eduardo Bassini can be considered the father of modern inguinal hernia surgery, but the Lichtenstein hernioplasty procedure, with the placement of a polypropylene mesh on the posterior inguinal wall after the inguinal hernia repair, is now the one of the most commonly used surgical methods for hernia repair,with a reported recurrence rate of 0-2% [3,4]. Chronic pain is the most significant postoperative problem following Lichtenstein hernia repair, reported at around 10% [2].
In 276 patients with direct or indirect inguinal hernia, 304 modified Lichtenstein hernioplasty procedures were performed following informed patient consent. This operational procedure was not used for femoral hernia repair. The operations were performed with the patients in the supine position, under general or spinal anesthesia. The inguinal canal, which is formed by four walls, can easily be triangulated by performing an extended surgical dissection between the aponeuroses of the external and internal oblique abdominal muscles as far as their intersection, as shown in Figure 1. Inguinal canal access was provided by cutting the aponeurosi
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