Lichtenstein tension-free hernioplasty: Its inception, evolution, and principles

Abstract

To circumvent the degenerative nature of inguinal hernias and adverse effect of suture line tension, the Lichtenstein tension-free hernioplasty began in 1984 and evolved (between 1984 and 1988) to a procedure that is now considered the gold standard of hernia repair by the American College of Surgeons. The objective of this paper is to outline the reasons behind the minor changes made during the short, 4-year evolution of the technique, describe the key principles of the operation, and introduce a new mesh that, if elected to be used, automatically satisfies all the key principles of the procedure and guides the surgeon to perform the operation correctly. The worldwide reported result of the operation by experts and nonexperts alike is a recurrence and complication rate of less than 1%. When the key principles of the procedure, which, as reported by many authors, are easy to learn, perform, and teach, are respected, the operation results in an effectiveness (external validation) that is virtually the same as its efficacy (results of the experts), attesting to the simplicity of the procedure.

International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery

“…Although it is generally believed to be difficult to see this small nerve, its location can be easily determined by the so called visible ''blue line'' [18], consisting of the external spermatic vein that is always adjacent to the nerve. It is not actually necessary to always identify the nerve, but it is important to know where is located and to save the external spermatic vessels, reserving its identification only in case of bleeding of the external spermatic vessels or in case of cremasteric muscle resection.…”

Prospective study on the effects of a polypropylene prosthesis on testicular volume and arterial flow in patients undergoing surgical correction for inguinal hernia

“…It is safe, simple, efficient and easy to learn, and it presents high satisfaction rates. A prosthesis positioned anteriorly above the fascia transversalis provides a cure for a hernia, because it covers the whole region of the inguinal floor, is a tension-free repair and also protects the whole region where the tissue presents metabolic defects, with regard to future occurrences 5 . The advances that polypropylene prostheses have brought to hernia treatment are undeniable.…”

“…Over the evolution of treatments for inguinal hernia, it has been discovered that the use of prostheses is fundamental for obtaining low recurrence rates and high satisfaction rates 3,4,5 . The euphoria triggered by the results from multicenter studies regarding the use of prostheses made many authors conclude that the possibility of recurrence and the postoperative complications from inguinal hernias were problems that had been solved 6,7,8 .…”

“…The euphoria triggered by the results from multicenter studies regarding the use of prostheses made many authors conclude that the possibility of recurrence and the postoperative complications from inguinal hernias were problems that had been solved 6,7,8 . The following complications caused by the use of prostheses have been described: fistulas, infection, extrusion, chronic pain, migration of the prosthesis to the bladder and to the intestines, and peritoneal adherence 5,9 . Nyhus 10 overcome various fears and encouraged the scientific community to use prostheses.…”

A Prospective Randomized Controlled Study of Lichtenstein's Tension Free versus Modified Bassini Repair in the Management of Groin Hernias

“…Several methods have been developed over the years to improve on the traditional methods of hernia repair, the most important being the Lichtenstein mesh repair [1][2][3] and laparoscopic mesh repair [3,4]. The aim of this trial was to determine if, in the hands of an average surgeon and residents, there were any benefits to be gained from using the mesh repair as opposed to the commonly used modified Bassini repair.…”