Open "tension-free" repair of inguinal hernias: the Lichtenstein technique

Abstract

Objective: To report our results with an open, tension free technique of repairing primary inguinal hernias using polypropylene (Marlex) mesh under local anaesthesia.

Design: Open study.

Setting: Specialist clinic, USA.

Subjects: 3480 Out of a total of 4000 men whose primary inguinal hernias were repaired between June 1984 and June 1995.

Interventions: Hernia repair involving total reinforcement of the transversalis fascia with mesh.

Main outcome measure: Morbidity, particularly recurrence.

Results: A total of 1776 (44.4%) were direct hernias, 1724 (43.2%) indirect, and 500 (12.5%) a combination; 456 (11.4%) were sliding hernias. Patients were followed up for a mean of 51/2 years (range 1-11) and 520 were lost to follow-up, leaving 3480 (87.0%) for analysis. All patients followed up were examined by a physician. There were five recurrences (0.1%), four at the pubic tubercle and one in which the mesh had torn away from the inguinal ligament because it was too narrow. There has been one recurrence in the last six years of the study. One patient developed orchitis. There was one case of postoperative neuralgia. There were no seromas that required aspiration. Most patients had returned to work within two weeks, including the manual workers.

Conclusion: Repair of primary inguinal hernias under local anaesthesia with the open, tension-free technique using polypropylene mesh results in acceptable morbidity, and appreciable reductions in postoperative discomfort, duration of hospital stay, recurrence rate and costs.