In the Lichtenstein open mesh repair of inguinal hernia, the mesh is sutured to which structure at its medial end to prevent recurrence at the pubic tubercle?

• A Transversalis fascia
• B Lacunar ligament (Gimbernat's ligament)
• C Conjoint tendon (inguinal falx)
• D Anterior rectus sheath and pubic periosteum ✓

Explanation

In Lichtenstein tension-free mesh repair, the medial end of the mesh is anchored to the anterior rectus sheath and the periosteum of the pubic tubercle with non-absorbable sutures to prevent mesh migration and medial recurrence. The inferior edge is sutured to the inguinal ligament; a slit in the mesh accommodates the spermatic cord to create an artificial internal ring. Failure to properly anchor the medial end leads to the most common site of recurrence after Lichtenstein repair.

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.