2024-03-25 22:43:54
A standard method to treat an inguinal hernia is Lichtenstein surgery. What speaks for how the operation works and what disadvantages it has.
The most important things at a glance
An inguinal hernia – also called an inguinal hernia or inguinal hernia – can only be cured through surgery. If the fracture is left untreated, it can grow larger over time and cause increasing problems – sometimes life-threatening complications. That’s why experts usually recommend inguinal hernia surgery.
The aim of every inguinal hernia operation is to push the peritoneum and intestines that have passed through the gap in the abdominal wall back into the abdominal cavity and to close the gap. The procedure is carried out openly – i.e. through a longer incision from the outside – or minimally invasively during a laparoscopy.
- During minimally invasive procedures, the doctor always uses a fine plastic mesh to strengthen the weak point in the abdominal wall.
- During open procedures, depending on the surgical method, the weak point in the abdominal wall is also reinforced with a mesh or sutured to neighboring body tissue.
A frequently used open surgical method with mesh is the inguinal hernia operation according to Lichtenstein. After many years of experience, it is one of the most important procedures worldwide for the treatment of inguinal hernias.
However, Lichtenstein inguinal hernia surgery is not always the best choice. Which surgical procedure is ultimately used depends on individual factors: for example, the location and size of the fracture as well as the age and state of health of those affected.
Who is eligible for Lichtenstein inguinal hernia surgery?
According to previous experience, the Lichtenstein inguinal hernia operation is ideal for men who
- the hernia is very large,
- the hernia has penetrated into the scrotum (testicular hernia or scrotal hernia),
- an inguinal hernia has ever occurred and was operated on minimally invasively,
- extensive surgery has previously taken place in the small pelvis (such as surgical removal of the prostate or urinary bladder or vascular surgery)
- the procedure should be carried out under local anesthesia or
- There are other medical reasons against a minimally invasive surgical procedure.
Lichtenstein inguinal hernia surgery is also an option for women. However, experience shows that open surgery is more likely to lead to a relapse than minimally invasive surgery. In addition, women are more likely to have hidden femoral fractures, which are more easily overlooked in open surgery. Therefore, a minimally invasive procedure is often considered the better choice for women.
In children, inguinal hernias can be operated on both minimally invasively and openly. However, a network is not used. The inguinal hernia operation according to Lichtenstein is generally not suitable for children.
How does Lichtenstein inguinal hernia surgery work?
The inguinal hernia operation according to Lichtenstein usually takes place under general anesthesia. Some of those affected also receive spinal anesthesia or local anesthesia. Once the administered agents have had their full effect, the surgeon makes an incision several centimeters long in the skin above the inguinal ligament
- to expose the hernial sac, check its contents (and care for them if necessary),
- to push the hernia contents back into the abdominal cavity and remove the hernia sac,
- to close the peritoneum with a suture and finally
- cover the area with a plastic mesh and sew it to the inguinal ligament and an abdominal muscle.
Inguinal hernia surgery according to Lichtenstein has advantages and disadvantages
Every procedure in hernia surgery has advantages and disadvantages – including the inguinal hernia operation according to Lichtenstein. Advantages arise, for example, from the mesh used: Compared to other open procedures, in which only a suture stabilizes the weak point in the abdominal wall, this means that after the Lichtenstein operation
- Relapses less common and
- Loads can be restored more quickly.
As an open surgical procedure, the Lichtenstein operation also has the advantage that – in contrast to minimally invasive procedures – it can also be carried out under local or partial anesthesia and is probably less likely to result in vascular injuries. But Lichtenstein’s inguinal hernia surgery also has disadvantages compared to minimally invasive procedures. Because after an open procedure
- Comparatively stronger pain is noticeable (although after the Lichtenstein operation, thanks to the mesh, less pain can be expected than after suture-based procedures).
- Bruising may occur a little more often.
- It will take a few days longer until physical activity and work are possible again.
- Wound infections, discomfort and chronic groin pain are more likely to occur.
Complications are rare
The plastic mesh used in Lichtenstein inguinal hernia surgery only occasionally causes problems such as pain or inflammation. Other complications are also rare with the Lichtenstein operation – as with all other common procedures for the treatment of inguinal hernias. However, they cannot be completely ruled out. Possible risks include:
- unintentional injuries (e.g. to nerves or intestines) during the operation
- in men: narrowing of the spermatic cord
- sudden vascular occlusion (thrombosis, embolism) during or after the operation
- Infection of the surgical wound
- chronic groin pain
- new inguinal hernia (relapse, technical term: recurrence)
Experience of the operators plays a major role
How high the risk of a recurrence is after inguinal hernia surgery depends less on the procedure used. What is more important is how experienced the surgeon is: if all operators have sufficient experience, minimally invasive procedures and open operations such as Lichtenstein’s inguinal hernia operation show a similar relapse rate.
Overall, up to 15 percent of people who undergo Lichtenstein inguinal hernia surgery subsequently experience another hernia. However, the risk is significantly lower if the surgeon is very experienced in the technique.
Good to know
Open surgical procedures are easier to learn than minimally invasive procedures. It can be assumed that a doctor has to operate on up to 100 inguinal hernias in a minimally invasive manner in order to be able to deliver the same good results as with Lichtenstein inguinal hernia surgery.
Conclusion: The most important things about inguinal hernia surgery according to Lichtenstein in brief
Based on many years of experience, the Lichtenstein inguinal hernia operation is one of the most important procedures in hernia surgery worldwide. This is an open, external procedure in which the doctor reinforces the weak point in the abdominal wall with a mesh. This procedure is particularly suitable for very large hernias and after relapses. If the operators are experienced, the risk of relapses and other avoidable complications is very low.
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