Page 33 - herina surgery and possible lawsuits

Lichtenstein onlay patch repair: .[70]

• Lichtenstein introduced the current concept of the “tension free” polypropylene mesh
repair as an office procedure under local anesthesia, into everyday, common practice

and because of that onlay hernia surgery with mesh is known as “Lichtenstein’s
tension free hemioplasty”. [70]
• Lichtenstein’s group had produced excellent results and had recurrence rate of 0.2%,

even non expert surgeons obtain the excellent result and had recurrence rate less than
0.5%.[70] Lichtenstem technique of onlay tension-free mesh did not need a long
learning curve to obtain highly acceptable results in the hands of general surgeons

make it the choice of method for hernia surgery by them.

In this technique, a sheet of prosthetic mesh measuring about 5 by 10 cm is used. The lower
edge is attached by a continuous suture of 2/0 prolene which secures the mesh medially to the

lacunar ligament and then proceeds laterally along inguinal ligament beyond the internal ring.
A slit m the mesh at the internal ring allows emergence of the spermatic cord. The superior

edge of the mesh secured with a similar continuous suture to the rectus sheath and conjoined
muscle and tendon above.

Figure 9: Lichtenstem onlay patch.

Mesh sutured from the transversus
arch to the shelving edge of the
inguinal ligament creating a "tension-
free" repair. [70]

(Courtesy: M. Kurzer et al / Surg Clin
N Am (2003))

PerFix plug and patch repair:

• Irving Lichtenstein first to introduce tightly rolled cylindrical or cigarette plug as

treatment of femoral and recurrent inguinal hernia. This design improved by Arthur
Gilbert in to a cone or umbrella shape.

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