General Surgery

Inguinal Hernia Repair (Open) (Lichtenstein)

OPERATION: Open Lichtenstein Tension-Free Mesh Inguinal Hernia Repair (Right / Left)
ANAESTHETIC: General / spinal / local anaesthesia
POSITION: Supine

INDICATION:
Symptomatic [direct / indirect] inguinal hernia. Consent included discussion of mesh, chronic groin pain risk, recurrence, and risk to vas deferens and testicular vessels.

PROCEDURE:
WHO Checklist performed. Oblique incision 2–3 cm above and parallel to the medial inguinal ligament. Dissection through Scarpa's fascia. External oblique aponeurosis incised in line with its fibres through the superficial inguinal ring.

Ilioinguinal nerve identified and preserved. Spermatic cord mobilised from the floor of the inguinal canal and slung.

Hernia sac identified: [direct / indirect]. Indirect sac: dissected from cord coverings back to the deep ring, opened to confirm no bowel contents, transfixed at its neck with absorbable suture. Direct sac: posterior wall defect plicated with absorbable suture.

Haemostasis confirmed. Polypropylene flat mesh trimmed to fit. Keyhole created for cord. Mesh fixed to pubic tubercle medially, inguinal ligament inferiorly (continuous absorbable / non-absorbable suture), and internal oblique superiorly (interrupted sutures). Tails secured around cord at deep ring without constriction.

Cord replaced. External oblique closed over mesh. Scarpa's fascia approximated. Skin closed subcuticularly / clips.

Testis confirmed in normal position.

FINDINGS:
[Direct / indirect] inguinal hernia, [size]. Sac contents: [empty / omentum / bowel — all viable]. [Lipoma of cord excised if present].

EBL: Minimal. COMPLICATIONS: None.

POST-OPERATIVE INSTRUCTIONS:
Regular analgesia. Light activities for 2 weeks. Avoid heavy lifting for 4–6 weeks. Return to work depending on occupation.