A 40-year-old male patient has undergone a surgical procedure for a swelling in his left groin. The image of the procedure is as shown. What procedure has been performed?
Lichtenstein's repair
The procedure is Lichtenstein's repair, the standard open tension-free mesh repair of inguinal hernia. A flat polypropylene sheet is laid over the posterior wall of the inguinal canal, fixed medially to the pubic tubercle and rectus sheath, inferiorly to the inguinal ligament and superiorly to the conjoint tendon, with a slit in its lateral end forming a new deep ring around the cord. Because it reinforces rather than approximating tissue under tension, recurrence falls to about 1 to 2 per cent.
The others are tissue (non-mesh) repairs. Bassini's repair approximates conjoint tendon to inguinal ligament behind the cord, with higher recurrence. Shouldice repair is a four-layer double-breasted continuous imbrication of transversalis fascia and conjoint tendon to the inguinal ligament - the best pure tissue repair but technically demanding. Desarda's repair uses an undetached strip of external oblique aponeurosis as a mesh-free physiological reinforcement. None uses the prosthetic sheet seen here.
Key point: Mesh over the posterior wall with a lateral slit around the cord equals Lichtenstein, the reference standard open repair.
Important Questions from Abdominal Wall
Which of the following are features of umbilical hernia in adults?
1. Patients are commonly overweight with a thinned and attenuated midline raphe.
2. Most patients complain of pain due to tissue tension.
3. Men are affected more commonly than women.
4. Hernia repair can be done by the technique described by Mayo.
Select the correct answer using the code given below.
- A 45 year old male patient, a known case of left inguinal hernia presents to the emergency with an acute onset of pain abdomen associated with nausea, vomiting and abdominal distension. His pulse rate is $102/min$, BP is $100/70$ mm Hg and respiratory rate is $24/min$. On local examination, the skin overlying the swelling is tense and erythematous. There is localized tender- ness over the swelling; the swelling is irreducible with absence of cough impulse. The most probable clinical diagnosis in this patient is
- Mayo's repair is done for
- A 45 year old male patient, a known case of left inguinal hernia presents to the emergency with an acute onset of pain abdomen associated with nausea, vomiting and abdominal distension. His pulse rate is $102$/min, BP is $100/70$ mm Hg and respiratory rate is $24$/min. On local examination, the skin overlying the swelling is tense and erythematous. There is localized tender- ness over the swelling; the swelling is irreducible with absence of cough impulse. The most probable clinical diagnosis in this patient is
- Mayo's repair is done for
