The Lichtenstein tension-free open hernioplasty uses a mesh placed in which anatomical plane?
- A Over the posterior wall of the inguinal canal, anterior to the transversalis fascia ✓
- B Preperitoneal (behind the transversalis fascia)
- C Onlay: anterior to the external oblique aponeurosis
- D Between the external oblique aponeurosis and the internal oblique muscle (retromuscular, subfascial)
Correct answer: A. Over the posterior wall of the inguinal canal, anterior to the transversalis fascia
Explanation
The Lichtenstein repair places a flat polypropylene mesh over the posterior wall of the inguinal canal (the transversalis fascia/conjoint tendon region), anterior to the transversalis fascia. The mesh is sutured to the inguinal ligament below, the conjoint tendon medially, and a slit is fashioned for the spermatic cord. This is an anterior (groin) approach, not preperitoneal. The preperitoneal plane is used in Stoppa, TEP, and TAPP repairs.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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