A 65-year-old man presents with a strangulated inguinal hernia. At surgery, the herniated bowel is found to be viable after warm saline application. The hernia is a large direct hernia with a wide neck. Which repair technique is most appropriate in this setting?

• A Tension-free mesh hernioplasty (Lichtenstein) ✓
• B High ligation of the sac alone without repair of the posterior wall
• C Shouldice repair with posterior wall reconstruction
• D McVay repair with Cooper's ligament

Explanation

In a large direct inguinal hernia with bowel viability restored, tension-free mesh hernioplasty (Lichtenstein) is the standard of care. The wide neck of a direct hernia means the internal ring is intact, and mesh provides reinforcement of the weakened posterior wall. High ligation alone (option B) is only appropriate for pediatric hernias. Shouldice and McVay repairs are tissue-based repairs with higher tension and recurrence rates in large defects.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.