THE LICHTENSTEIN OPEN TENSION-FREE MESH REPAIR OF INGUINAL-HERNIAS

All standard methods of hernia repair involve suturing together tissue s which are not normally in apposition. This violates the basic surgic al principle that tissue must never be approximated under tension and thus accounts for an unacceptable number of failures, A total reinforc ement of the inguinal floor with a sheet of suitable biomaterial and t he employment of a ''tension-free'' technique is a more effective appr oach, Since June 1984, 4,000 primary inguinal hernias have been repair ed on an outpatient basis and under local anesthesia at the Lichtenste in Hernia Institute by the open ''tension-free'' technique using Marle x mesh. The patients were followed from 1 to 11 years by physician exa mination, The follow-up rate was 87%. There were four recurrences, The causes of recurrence and how to avoid them are herein discussed. Thre e of the recurrences occurred at the pubic tubercle and were caused by placing the mesh in juxtaposition to the tubercle, This error has sin ce been corrected by overlapping the mesh at the pubic bone, One recur rence was caused by a disruption of the lower edge of the mesh from th e shelving margin of Poupart's ligament, The error here was the utiliz ation of a patch that was too narrow and therefore under tension, It b ecame apparent that a wider patch, fixed in place with an appropriate degree of laxity, was required.