In the Lichtenstein tension-free mesh repair for inguinal hernia, the mesh is placed in which tissue plane?
- A Between the external oblique aponeurosis and the internal oblique muscle (onlay repair)
- B Pre-peritoneal (totally extraperitoneal) space
- C On top of the posterior wall of the inguinal canal (Hesselbach's triangle) beneath the external oblique aponeurosis ✓
- D Intra-abdominal (intraperitoneal onlay mesh — IPOM)
Correct answer: C. On top of the posterior wall of the inguinal canal (Hesselbach's triangle) beneath the external oblique aponeurosis
Explanation
The Lichtenstein repair is an open anterior tension-free mesh repair. The mesh is placed flat on the posterior wall of the inguinal canal (inguinal floor) covering the internal inguinal ring and Hesselbach's triangle, sutured to the inguinal ligament inferiorly and the conjoint tendon/internal oblique superiorly. It lies beneath the opened external oblique aponeurosis. The TEP and TAPP laparoscopic repairs place mesh in the pre-peritoneal space. IPOM places mesh intraperitoneally and is used primarily for ventral hernias.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.