Details regarding the Lichtenstein technique
Enhanced HandlingThe basic principle of the Lichtenstein hernia repair is a tension free mesh augmentation of the inguinal region after conventional preparation and reduction of the hernia.
Several studies show a high rate of patients with chronic pain after Lichtenstein hernia repair. Dr. Helmar Gai is a well-known German hernia specialist with an experience of more than 6000 Lichtenstein repairs. He worked at the private clinic Fleetinsel in Hamburg and currently at the hernia centre Dr. Muschaweck Munich. He has some recommendations to minimize this rate.
Details of Dr. med. Helmar Gai regarding the Lichtenstein technique
The operation should be done under local anaesthesia using a combination of nerve blockade and infiltration. Thus, atypically running nerves can easily be identified and unnecessary traumatisation can be avoided.
A direct hernia usually does not need any special treatment before mesh implantation. Only large direct hernias should be treated by a running suture without tension to facilitate the mesh fixation after reduction.
According to the original description of Lichtenstein for all indirect hernias only a reposition of the hernia sac should be done. After own experience it seems to be safer to invert the hernia sac after performing a circular purse-string suture at the base.
There is a minimum size for a mesh for the Lichtenstein repair. The length between pubic tubercle and internal ring usually is 7 cm. The length of the flaps which are surrounding the spermatic cord should be about 5 cm. The mesh must always be adapted to the patient and never the patient to the mesh. Therefore, the DynaMesh®-LICHTENSTEIN has dimensions complying with these requirements. For an average sized patient the mesh should be cut at the caudal rounded area for about 1-2 cm.
The main interest is focussed to the new internal ring. On one hand there is a risk of compressing the cord structures when it is too narrow and on the other hand the risk that the new internal ring is too wide. The absolutely new warp-knitted structure of the DynaMesh®-LICHTENSTEIN allows an ideal adaptation because there is no risk that the mesh can rupture along the incision even if the slit has to be prolonged.
PVDF is the recommended mesh material. After many years of application in surgical disciplines this monofilament has proven its worth. It offers an extreme high biocompatibility and biostability.
For the medial fixation of the mesh to the aponeurosis of the internal oblique abdominal muscle so called “air knots” are recommended. This should guarantee that invisible subfascial nerves are not part of a tight knot.
It is standard that the patient is walking out of operating room himself.
Using DynaMesh®-LICHTENSTEIN, advantages of this method are:
- safe and timesaving handling
- less postoperative pain
- fast convalescence and quick return to normal physical activities
- long term safety for patients
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