Lichtenstein tension-free mesh repair uses which anatomical layer for mesh placement, and what is the recurrence rate advantage over traditional tissue repairs?

• A Mesh placed in the preperitoneal space; recurrence rate <1% vs. 10-15% for Bassini repair
• B Mesh placed beneath the transversalis fascia; recurrence rate identical to Shouldice repair
• C Mesh placed on the anterior surface of the posterior inguinal wall between external oblique aponeurosis and the inguinal floor; recurrence rate <2% vs. 10-15% for tissue repairs ✓
• D Mesh placed in the retroinguinal space of Bogros; recurrence rate <0.5%

Explanation

Lichtenstein repair places a flat polypropylene mesh on the anterior surface of the posterior inguinal canal floor, secured to the inguinal ligament inferiorly and the conjoint tendon/transversus abdominis aponeurosis superiorly, with a slit created for the spermatic cord. It is tension-free, with recurrence rates of 1-2%, compared to 10-15% for pure tissue repairs (Bassini, Shouldice). Shouldice repair (multilayer running suture of the transversalis fascia) is the best tissue repair with ~1-2% recurrence in specialized centres. The space of Bogros is used in preperitoneal approaches (Stoppa, TEP).

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.