1. Stoppa's repair
2. Lichtenstein's repair
3. Laparoscopic TEP repair
4. Desarda's repair
Select the correct answer using the code given below.
Tension-Free Inguinal Hernia Repairs
A tension-free repair is one in which the herniated defect is bridged or reinforced using a prosthetic mesh, so that native tissues are not sutured together under tension. This is the principle that revolutionized hernia surgery and dramatically reduced recurrence rates compared to older tissue-approximation techniques.
Analyzing Each Technique
- 1. Stoppa's repair: A giant prosthetic reinforcement of the visceral sac placed in the preperitoneal space via a large mesh. It is a classic mesh-based, tension-free repair, typically used for bilateral or complex/recurrent hernias.
- 2. Lichtenstein's repair: The gold-standard open repair, in which a flat polypropylene mesh is sutured over the posterior wall of the inguinal canal without approximating the conjoint tendon to the inguinal ligament under tension. This is the prototype tension-free mesh repair.
- 3. Laparoscopic TEP (Totally Extra-Peritoneal) repair: A minimally invasive approach that places a large mesh in the preperitoneal space without entering the peritoneal cavity. Like TAPP, it is a mesh-based, tension-free technique.
- 4. Desarda's repair: This is a non-mesh, tissue-based repair that uses a strip of the patient's own external oblique aponeurosis as a new "reinforcement layer" for the posterior wall. Because it relies on autologous tissue rather than prosthetic mesh, it is classified alongside repairs like Shouldice/Bassini/McVay as a tissue (tension) repair, not among the standard tension-free mesh repairs, even though its proponents claim reduced tension compared to classic suture repairs.
Why the Other Options Are Incorrect
- "1, 2 and 4" and "2, 3 and 4" and "1, 3 and 4" are all incorrect because each wrongly includes Desarda's repair, which is a mesh-free, tissue-based reconstruction and is conventionally excluded from the "tension-free" (mesh) group in standard surgical classifications.
Conclusion
The three procedures that are genuinely mesh-based tension-free inguinal hernia repairs are Stoppa's repair, Lichtenstein's repair, and Laparoscopic TEP repair, corresponding to statements 1, 2 and 3. Desarda's repair (statement 4), being a non-mesh autologous tissue repair, is correctly excluded, making "1, 2 and 3" the correct answer.
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
