Evidence - Lichtenstein Repair of Inguinal Hernia - general and visceral surgery
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Compared to sutured open herniorraphy in adults (particularly the Shouldice procedure), in surgical repair of (unilateral and bilateral) inguinal hernia by the Lichtenstein technique the following differences have been reported:
- Lower recurrence rate (↑↑ [6; 8; 11; 12; 15; 21])
- Probably somewhat shorter operating time (↑↑ [6; 12; 15; 20; 21])
- Perhaps somewhat less postoperative pain, in the long run apparently comparable pain (↑↑ [3; 11; 13; 18; 20-22])
- Perhaps somewhat speedier recovery (↑↑ [3; 6; 18; 21])
- Comparable rate of infection (↑↑ 21)
- May be performed under local anesthetics (↑↑ 11)
- More expensive because of cost of mesh (↑ 18)
- For comparison of the Lichtenstein repair with other procedures please see there: Inguinal herniorraphy with Rutkow plug, TAPP and TEP.
The comparison fociused on heavy and light-weight meshes (100 g/cm2 and 30g/cm2 respectively). Outcome of the light-weight meshes:
- Less foreign body sensation in the groin (↑ [5; 19])
- Trend of less chronic groin pain (↑ [5; 19])
- Comparable recurrence rates (↑ 5)
In addition, several mesh materials were studied. The comparison of Prolene®, Vypro II®, Premilene® and Surgisis® resulted in the following:
- No significant differences in the perioperative course (↑↑ [1; 4; 17])
Sutures, sealants, skin staples and spiral tacks used in mesh fixation were also studied. The outcome was as follows:
- After mesh fixation by sealant perhaps somewhat less postoperative pain (↑ [9; 10; 16])
- With staples and tacks somewhat shorter operating time (↑ [7; 14])
- Comparable recurrence rates overall (↑ [7; 9; 10; 14; 16])
Routine prophylactic antibiotic protocol in Lichtenstein repair resulting in:
- Evidently no reduction in the rate of wound infection (↑ 2)
Ongoing trials on this topic
References on this topic
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- Bringman S, Wollert S, Osterberg J, Smedberg S, Granlund H, Heikkinen TJ. Three-year results of a randomized clinical trial of lightweight or standard polypropylene mesh in Lichtenstein repair of primary inguinal hernia. Br J Surg 2006; 93: 1056-9.
- Danielsson P, Isacson S, Hansen MV. Randomised study of Lichtenstein compared with Shouldice inguinal hernia repair by surgeons in training. Eur J Surg 1999; 165: 49-53.
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1. Köckerling F, Schug-Pass C. Tailored approach in inguinal hernia repair – decision tree based on the guidelines. Front Surg. 2014 Jun 20;1:20.
2. Pisanu A, Podda M, Saba A, Porceddu G, Uccheddu A. Meta-analysis and review of prospective randomized trials comparing laparoscopic and Lichtenstein techniques in recurrent inguinal hernia repair. Hernia. 2015 Jun;19(3):355-66.
3. Antoniou SA, Pointner R, Granderath FA. Current treatment concepts for groin hernia. Langenbecks Arch Surg. 2014 Jun;399(5):553-8. doi:
4. Bracale U, Melillo P, Pignata G, Di Salvo E, Rovani M, Merola G, Pecchia L. Which is the best laparoscopic approach for inguinal hernia repair: TEP or TAPP? A systematic review of the literature with a network meta-analysis. Surg Endosc. 2012 Dec;26(12):3355-66.