Lichtenstein hernioplasty surgery ppt.pptx

Surgery- lichtenstein hernioplasty

1. Lichtenstein hernioplasty Presented by - Roll no . – 19005

2. Introduction - Lichtenstein tension free mesh hernioplasty is used for the management of inguinal hernia . In this procedure the posterior wall is strengthened by a prolene mesh . The fibroblast and capillaries grows over the mesh , converting it into thick fibrous sheath and strengthening the posterior wall .

3. In this procedure polypropylene mesh is used . 8×16 cm mesh is tailored to patient requirement. Preparation of mesh – corners can be cut so as to give round shape . A slit is given on the lateral border of the mesh at the junction of lower one – third and upper two – third , to allow spermatic cord to pass through . Suturing – medially the mesh overlaps the pubic tubercle and is sutured over the tissue of symphysis . Laterally , the two tails are placed beyond deep ring and sutured . Inferiorly , it is sutured to inguinal and lacunar ligament and superiorly to conjoint tendon

4. Advantages of polypropylene mesh High tensile strength . Biocompatible , non – absorbable Monofilament strong , elastic and transparent mesh Ideal porosity or high visibility and colonisation . Strong mechanical reinforcement . Encourages rapid ingrowth of connective tissue . Cheaper Flexible for any anatomical placement . Advantage of light weight and large pores mesh – Less shrinkage of mesh , more flexible , better tissue integration , better comfort

5. Characteristics of ideal mesh - Biocompatibility means it should not do any harm , should be chemically and physically inert . Risk of infection should not be there . Handling should be good . Economical Longevity

6. Steps - Inguinal incision is made by cutting skin and superficial fascia . The external oblique aponeurosis is incised . Superficial ring is incised being careful not to injure ilioinguinal nerve The cord structures are dissected , and a sling is placed . Once the deep ring is reached a glistening white structure or hernial sac is visible . Sac is dissected out , incised and opened with artery forceps . The contents of the sac are pushed back The sac is twisted , transfixed and excess sac is removed by cutting it . Than a mesh is used . It needs to be big enough to accommodate the cord structures and for shrinkage .

7. The first bite to fix the mesh is taken close to the pubic tubercle and not through the pubic tubercle [ causes chronic inguinal pain ] The mesh is placed around the cord structures by making sure not to entrap the iliohypogastric nerve . Mesh is secured behind the cord structures as well . The sling is removed . External oblique aponeurosis is closed and a new superficial ring is made . Subcutaneous layer and skin incised is closed