Groin hernia repair with mesh
Lichtensteinprocedure
Nowadays at the groin hernia operation frequently artificial material is used to reinforce weak spot in the abdominal wall. This is done because the results are clearly better with this technique than with the older techniques where the tissue layers around the weak spot in the abdominal wall are sewn to each other.
In the example shown below there is a hernia on the left side.
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Through an incision above the groin fold the skin and the underlying tissues (1) are opened until the fascia of the abdominal muscle is reached (2). An extension of this muscle with the vessels and semen duct (spermatic cord) run from the abdominal cavity to the scrotum.
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The fascia is opened and the spermatic cord is freed and held up with a rubber band (yellow on the photograph, 3). From the spermatic cord the hernia sac is now freed (4). Attention is paid not to damage the blood vessels and the semen duct (5). The hernial sac is opened and the surgeon makes sure that there are no vital structures in the hernial sac(6). In fact there is an open connection with the abdominal cavity after opening the hernial sac. The instrument on the photograph indicates the access (7). The hernial sac is removed after suturing it on the spot where it enters the abdominal cavity. In this case there is also a weak spot besides the removed hernial sac (7).
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A mesh (8) is sutured to the pubic bone in the midline, to a tendon in the groin and to the abdominal muscel. The spermatic cord runs through a slit of the mesh which is closed behind it (9). In this way a good strengthening of the abdominal wall has been obtained, without tension on the tissue layers (10). The skin has been been sutured subcutaneously (11). Showering is permitted the day after the operation and all activities can be resumed on guidance of the complaints.