In Lichtenstein's tension-free mesh hernioplasty for an indirect inguinal hernia, the mesh is positioned. At which landmark is the lateral slit in the mesh placed to recreate the deep inguinal ring?

• A Around the femoral vessels medially
• B Below the inguinal ligament over the femoral sheath
• C Around the cord structures at the deep inguinal ring with the two tails of mesh sutured lateral to the cord ✓
• D Around the pubic tubercle to reinforce the medial floor

Explanation

In Lichtenstein repair, a slit is made in the lateral end of the polypropylene mesh to accommodate the spermatic cord (or round ligament), creating a new internal ring with the two tails of the slit mesh. The upper tail (narrower) is passed deep to the lower tail (wider) and both are sutured to the inguinal ligament lateral to the cord, creating a new snug deep inguinal ring. This recreated ring is designed to prevent lateral prolapse of the cord and early recurrence. The medial overlap of the mesh beyond the pubic tubercle by 1-2 cm prevents medial recurrence. The mesh is fixed to the inguinal ligament below and the internal oblique above.

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.