Nerve Handling and Additional Fixation of a Self-adhesive Mesh in the Lichtenstein Method

Abstract

The Lichtenstein method (herein after referred to as this method) for adult inguinal hernia is strongly recommended in global guidelines, but the number of cases is still small in Japan. Since 2010, we have continued this method of active nerve identification, pragmatic neurectomy, and the additional fixation of a self-adhesive mesh. Intraoperative nerve handling, additional fixation of a mesh, and treatment results were retrospectively examined in patients who underwent this method in our hospital during the five-year period from 2014 to 2018. As a result, the iliohypogastric, ilioinguinal, and genital branches of the genitofemoral nerve were identified in 73%, 69%, and 85% of the cases, respectively, and the iliohypogastric nerve was resected in 49% of the cases. Additional fixation of the mesh was performed in all cases. There were only two cases of complications associated with surgery, including one case of recurrence. No chronic pain was observed. In this method, good treatment results were obtained by active nerve identification, pragmatic neurectomy, and the additional fixation of a self-adhesive mesh.