Some more time with an old friend: Small details for better outcomes with Lichtenstein repair for inguinal hernias

Lichtenstein repair (LR) was described by Irving Lichtenstein in mid-1980s, and was announced to be the gold standard for the treatment of inguinal hernias in 1990s. The technique is a tension-free repair with a prosthetic patch. Today LR is one of the most widely used surgical methods in the world, but it is hard to talk about uniformity in the technique among surgeons. Almost every surgeon has made some modifications to the technique and produced somewhat different repairs independently. In this paper, the original LR and the suggested modifications by the Institute are reviewed, and some critical points are presented with intraoperative photographs. LR is an economic choice, easy to learn, and can be performed with local anesthesia especially when the patient is frail. The technique requires a permanent prosthetic patch. Mesh fixation should be done with separate sutures preferably with monofilament absorbable material. Mesh size should not be kept small, and a 2-cm overlap should be provided beyond the pubic tubercle. A 15 cm × 7 cm commercial mesh can be trimmed and used. Mesh should extend laterally to the internal inguinal ring for 5–6 cm. A proper technique in LR is important for low recurrence and chronic pain rates. Therefore, every surgeon at every level of her/his carrier must know how to perform a decent LR.