Intraoperative Inguinal Measurements to Estimate a Single Optimal Mesh Size for Lichtenstein Inguinal Hernioplasty: an Observational Study

  • Mahadev M. Abhishek
  • Vishwanath M. Pattanshetti
Original Article


In inguinal hernia surgery, use of optimal mesh size during Lichtenstein hernioplasty technique is essential in preventing recurrence. This study was an attempt to determine a single optimal mesh size which can be adapted in vast majority of cases based on intraoperative inguinal measurements. This observational study was done for 1 year in the Department of Surgery, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, India. A total of 60 patients aged above 18 years who were scheduled for elective inguinal hernioplasty using the Lichtenstein technique for direct or indirect inguinal hernia were subjected to intraoperative measurements. All the patients were male with mean age of 52.75 ± 15.39 years. Mean body mass index (BMI) was 24.51 ± 3.10 kg/m2. With regard to hernia characteristics, most of the patients had right-sided hernia (61.7%), indirect (51.67%), and incomplete hernia (81.67%). The mean width of mesh required was 6.65 ± 0.24 cm and mean length was 13.75 ± 0.25 cm. The mesh size was comparable with respect to demographic characteristics, anthropometry, BMI, and type and extent of hernia (p > 0.050) but age and length of mesh size varied significantly in patients with direct and indirect type of hernia (p < 0.050). The present study made an attempt to determine a single optimal mesh size in cases who underwent inguinal hernia repair based on the principles of Lichtenstein hernioplasty, which being 6.7 cm × 13.8 cm. Another significant finding was varying in mesh length size between direct and indirect hernias.


Intraoperative measurements Lichtenstein hernioplasty Inguinal hernia Mesh size 


Compliance with Ethical Standards

The study was approved from the Institutional Ethical Committee, Jawaharlal Nehru Medical College, KLE University, Belagavi, India. The patients fulfilling selection criteria were informed about the purpose of this study and a written informed consent was obtained.

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Jenkins JT, O’Dweyer PJ (2008) Inguinal hernias. BMJ 336(7638):269–272CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Kingsnorth A, LeBlanc K (2003) Hernias: inguinal and incisional. Lancet 362:1561–1571CrossRefPubMedGoogle Scholar
  3. 3.
    Gandhi D, Marcin S, Xin Z, Asha B, Kaswala D, Zamir B (2011) Chronic abdominal pain secondary to mesh erosion into cecum following incisional hernia repair: a case report and literature review. Ann Gastroenterol 24(4):321–324PubMedPubMedCentralGoogle Scholar
  4. 4.
    Schumpelick V, Klinge U (2003) Prosthetic implants for hernia repair. Br J Surg 90:1457–1458CrossRefPubMedGoogle Scholar
  5. 5.
    Burger JWA, Luijendijk RW, Hop WCJ, Halm JA, Verdaasdonk EGG, Jeekel J (2004) Long-term follow-up of RCT of suture versus mesh repair of incisional hernia. Ann Surg 240:578–585PubMedPubMedCentralGoogle Scholar
  6. 6.
    Finan KR, Kilgore ML, Hawn MT (2009) Open suture versus mesh repair of primary incisional hernias a cost-utility analysis. Hernia 13:173–182CrossRefPubMedGoogle Scholar
  7. 7.
    Mahmoud Uslu HY, Erkek AB, Cakmak A, Sozener U, Soylu L et al (2006) Incisional hernia treatment with polypropylene graft: results of 10 years. Hernia 10:380–384CrossRefPubMedGoogle Scholar
  8. 8.
    Sauerland S, Schmedt CG, Lein S, Leibl BJ, Bittner R (2005) Primary incisional hernia repair with or without polypropylene mesh: a report on 384 patients with 5-year follow-up. Langenbeck's Arch Surg 390:408–412CrossRefGoogle Scholar
  9. 9.
    Basu I, Bhoj SS, Mukhopadhyay AK (2013) Retrospective study on prevalence of primary and recurrent inguinal hernia and its repairs in patients admitted to a tertiary care hospital. Indian Med Gaz:203–213Google Scholar
  10. 10.
    Desarda MP, Why hernia re-occurs again and again. Frontiers. [internet] posted on: 24–06-2012. Available from: Accessed 24 Oct 2013
  11. 11.
    Amid PK (2002) How to avoid recurrence in Lichtenstein tension-free hernioplasty. Am J Surg 184:259–260CrossRefPubMedGoogle Scholar
  12. 12.
    William NS, Bulstrode CJK (2013) Abdominal wall, hernia and umbilicus. In: Olonnel PR (ed) Bailey and love’s short practice of surgery, 26th edn. CRC Press, Florida, pp 957–958Google Scholar
  13. 13.
    Fitzgibbons R Management of an inguinal hernia: conventional? Tension-free? Laparoscopic? or maybe no treatment at all. General Sessions of the American College of Surgeons. 86th Annual Clinical Congress 2000.Google Scholar
  14. 14.
    Rabe R, Yacapin CPR, Buckley BS, Faylona JM (2012) Repeated in vivo inguinal measurements to estimate a single optimal mesh size for inguinal herniorrhaphy. BMC Surg 12:19CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    The EU Hernia Trialists Collaboration (2002) Repair of groin hernia with synthetic mesh: meta-analysis of RCT. Ann Surg 235:322–332CrossRefPubMedCentralGoogle Scholar
  16. 16.
    Lomanto D, Cheah WK, Faylona JM, Huang CS, Lohsiriwat D, Maleachi A et al (2015) Inguinal hernia repair: toward Asian guidelines. Asian J Endosc Surg 8(1):16–23CrossRefPubMedGoogle Scholar
  17. 17.
    Amid PK (2004) Lichtenstein tension-free hernioplasty: its inception, evolution, and principles. Hernia 8:1–7CrossRefPubMedGoogle Scholar
  18. 18.
    Seker D, Oztuna D, Kulacoglu H, Genc Y, Akcil M (2013) Mesh size in Lichtenstein repair: a systematic review and meta-analysis to determine the importance of mesh size. Hernia 17:167–175CrossRefPubMedGoogle Scholar
  19. 19.
    Amid PK (1997) Classification of biomaterials and their related complications in abdominal wall hernia surgery. Hernia 1:12–19CrossRefGoogle Scholar
  20. 20.
    Klinge U, Klosterehalfen B, Muller M, Ottinger AP, Schumpelick V (1998) Shrinking of polypropylene mesh in vivo: an experimental study in dogs. Eur J Surg 164:965CrossRefPubMedGoogle Scholar
  21. 21.
    Bringman S, Conze J, Cuccurullo D, Deprest J, Junge K, Klosterhalfen B et al (2010) Hernia repair: the search for ideal meshes. Hernia 14(1):81–87CrossRefPubMedGoogle Scholar
  22. 22.
    Valenti G, Testa A, Capuano G (1998) Anthropometric measurements of the male inguinal canal. Minerva Chir 53(9):715–718PubMedGoogle Scholar
  23. 23.
    Nikolov S, Beltschev B (1990) Several ultrastructural peculiarities of the fascia transversalis in direct inguinal hernias of senile men. Anat Anz 170:265–272PubMedGoogle Scholar
  24. 24.
    Das S (2004) A manual on clinical surgery. 6th ed., Calcutta: Dr. S. DasGoogle Scholar
  25. 25.
    Gopal SV, Warrier A (2013) Recurrence after groin hernia repair-revisited. Int J Surg 11(5):374–377CrossRefPubMedGoogle Scholar
  26. 26.
    Kux M (2002) Anatomy of the groin: a view from the surgeon. In: Nyhus and Condon’s Hernia. Fitzgibbons R, Greenberg G, eds. 5th ed. Philadelphia USA: Lippincott Williams and Wilkins p. 45.Google Scholar
  27. 27.
    Bay-Nielsen M, Nordin P, Nilsson E, Kehlet H, Base DHD, the Swedish Hernia Data Base (2001) Operative findings in recurrent hernia after a Lichtenstein procedure. Am J Surg 182:134–136CrossRefPubMedGoogle Scholar

Copyright information

© Association of Surgeons of India 2017

Authors and Affiliations

  • Mahadev M. Abhishek
    • 1
    • 2
  • Vishwanath M. Pattanshetti
    • 1
    • 2
  1. 1.Department of Surgery, Jawaharlal Nehru Medical CollegeKLE UniversityBelagaviIndia
  2. 2.KLES Dr Prabhakar Kore Hospital & MRCBelagaviIndia

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