Lichtenstein operation

The Lichtenstein operation is a method developed by the American surgeon Irving L. Lichtenstein to repair an inguinal hernia .

For this purpose, a plastic net, usually made of polypropylene, is inserted to reinforce the weakened abdominal wall .

1. First, after a skin incision, the uppermost layer of the abdominal wall muscles ( musculus obliquus externus abdominis ) is opened. This then presents the actual inguinal canal. Then the spermatic cord structures (in men these are the spermatic ducts, blood vessels supplying the testicles, the ilioinguinal nerve and finally a muscle residue) are identified and carefully held aside with a rubber band. Then the actual type of hernia can be identified - namely the direct inguinal hernia protruding directly through the inner abdominal wall or the indirect inguinal hernia which takes the detour via the inner inguinal ring.
2. The further procedure is then decided depending on the type of break. In the case of a direct inguinal hernia, this can usually be relocated directly back into the abdomen. In the case of indirect inguinal hernia, the so-called hernial sac must then be separated from the previously mentioned spermatic cord structures and opened. In most cases, there is no actual intestine in the hernial sac, but rather fatty tissue. If there is an intestine in the hernial sac, this intestine must be inspected for strangulations and only in very rare cases partially removed. The hernial sac is then closed at the base and, after removing excess parts of the hernial sac, sunk back into the abdomen.
3. Finally, it is mandatory to reinforce the weak inner abdominal wall by sewing on a plastic net in the form of a mesh that reinforces the rear wall of the inguinal canal. Only this introduction of the mesh defines this type of inguinal hernia operation as a so-called Lichtenstein operation. The procedure became popular in the late 1980s.

The special thing about the Lichtenstein operation is the placement of a plastic mesh between the inner and outer abdominal muscles or fascia, in contrast to the Stoppa surgery , in which the mesh comes to lie between the peritoneum and the inner abdominal wall. This intermuscular location enables technically easier removal in the event of rejection or inflammation.

The introduction of plastic grafts into the human organism should be carefully considered. The risk and benefit must be weighed.

Per:

• shorter operation compared to other plastics
• earlier resilience
• stable supply to the abdominal wall

Cons:

• Foreign bodies in the body
• Risk: the plastic net slipping
• Risk: rejection reaction, which leaves a confusing surgical field for a reoperation.
• Risk: Infection of the network, which in the worst case can lead to necrosis of the entire abdominal wall

See also

• Inguinal hernia surgery according to Shouldice
• Inguinal hernia operation according to McVay / Lotheisen
• Total extraperitoneal hernioplasty
• Transabdominal preperitoneal mesh implantation

Web links

• E-learning on various surgical topics, including inguinal hernias, with images and videos on the Lichtenstein operation
• Dissertation on Lichtenstein-Op from 2005

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !