In Lichtenstein tension-free mesh repair for inguinal hernia, the medial apex of the mesh is sutured to which anatomical structure to prevent medial overlap failure?
- A Conjoint tendon (falx inguinalis)
- B Cooper's ligament (pectineal ligament)
- C Pubic tubercle, overlapping it medially by at least 1.5–2 cm ✓
- D Anterior superior iliac spine
Correct answer: C. Pubic tubercle, overlapping it medially by at least 1.5–2 cm
Explanation
The Lichtenstein mesh must overlap the pubic tubercle by at least 1.5–2 cm medially to prevent recurrence at the medial angle of the repair — the most common site of recurrence if the mesh is placed too laterally. The mesh is fixed to the inguinal ligament below, conjoint tendon above, and must extend medially past the pubic tubercle. Cooper's ligament fixation is used in Stoppa/Nyhus repairs, not the anterior Lichtenstein technique.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.