ZenToks Publication

Chapter 10

The Lichtenstein Inguinal Hernia Repair: A Review

Abstract/Preface

Inguinal hernia repair is among the most frequently performed surgical procedures globally, yet the optimal surgical technique remains a subject of debate. This procedure entails the reinforcement of the posterior wall of the inguinal canal using a flat prosthetic mesh, which minimizes tissue tension and promotes rapid recovery. Numerous studies have reported recurrence rates of less than 2% when performed by experienced surgeons, thereby establishing it as the benchmark against which other open repair methods are evaluated. Compared to traditional tissue repairs, the Lichtenstein technique is associated with lower recurrence rates, reduced postoperative pain due to minimized tissue tension, and shorter operative learning curves. The Shouldice repair continues to be a valuable option for selected patients, particularly when mesh use is contraindicated or unavailable, although its success is highly contingent upon surgical expertise. While newer mesh-based techniques have demonstrated comparable recurrence rates, they have not consistently shown superior outcomes compared to the Lichtenstein repair. Despite concerns about chronic postoperative groin pain and mesh-related complications, the Lichtenstein repair remains a safe, effective, and cost-efficient procedure. Current evidence supports its continued status as the gold standard for open inguinal hernia repair, while highlighting the importance of individualized patient selection and surgeon expertise in determining the most suitable operative approach.