Published: 2021-01-29

A prospective comparative study of Lichtenstein procedure with and without mesh-fixation for inguinal hernia repair

Ravinder Kumar, Hilal A. Wani, Anshuman Mahesh, Irfan N. Mir


Background: Repair of inguinal hernia is one of the most common elective operations performed in general surgery worldwide. Mesh-hernioplasty became the gold standard, because of its low recurrence rate in comparison with tissue repairs. The ideal repair must be simple, safe, easy to perform and require minimal dissection which provides enough space, should be cost effective with less hospital stay, less pain and less recurrence. The present study aimed at comparing the effect of mesh fixation and non-fixation in Lichtenstein technique for inguinal hernia repair.

Methods: Hundred (100) patients with primary uncomplicated, unilateral inguinal hernia were treated between April 2019 and September 2020. Patients with inguinal hernia underwent Lichtenstein repair with mesh-fixation (group A) (n=50) and non-fixation (group B) (n=50). The mean operative time, post-operative pain score, average hospital study, post-operative complications and recurrence rates were compared between the two groups.

Results: Mean operative time in non-fixation group- (group B) (32.24 min) was shorter as compared to fixation group-(Group A) (49.36 min) with a p value of 0.002. Post-operative pain score was lower in (group B) at 12 and 24 hours (3.71±1.409 and 2.2±0.8169) as compared to Group A at 12 and 24 hours (4.77±1.196 and 2.98±1.295) with a p value of <0.0001. The analgesia required in (group B) was less as compared to (group A). The post-operative complication and recurrence rates were almost identical in both the groups, with lesser incidence of groin pain and paresthesias in group B.

Conclusions: In Lichtenstein inguinal hernia repair, non-fixation of mesh is safe and preferable option, with less operative time and less postoperative pain.


Hernia, Chronic groin pain, Mesh, Hernioplasty

Full Text:



Anadol AZ, Akin M, Kurukahvecioglu O, Tezel E, Ersoy E. A prospective comparative study of the efficacy of conventional Lichtenstein versus self-adhesive mesh repair for inguinal hernia. Surg Today. 2011;41(11):1498-503.

Eryoz F, Culu S, Duzkoylu Y, Bektas H. The comparison of Lichtenstein procedure with and without mesh- fixation for inguinal hernia repair. Surg Res Pract. 2016;8041515.

Fortelny RH, Petter-Puchner AH, Glaser KS, Redl H. Use of fibrin sealant (Tisseel/Tissucol) in hernia repair: a systematic review. Surg Endosc. 2012;26(7):1803-12.

Ladwa N, Sajid MS, Sains P, Baig MK. Suture mesh fixation versus glue mesh fixation in open inguinal hernia repair: a systematic review and meta-analysis. Int J Surg. 2013;11(2):128-35.

Koninger J, Redecke J, Butters M. chronic pain after hernia repair: a randomized trial comparing Shouldice, Lichtenstein and TAPP. Langenbecks Arch Surg. 2004;389:361-5.

Techapongsatorn S, Tansawet A, Kasetsermwiriya W. Mesh Fixation techniques for Inguinal hernia repair: protocol for an umbrella review with integrated and updated network meta-analysis. BMJ Open. 2019;9:e031742.

Canonico S, Benevento R, Perna G, Guerniero R, Sciaudone G, Pellino G, et al. Sutureless fixation with fibrin glue of lightweight mesh in open inguinal hernia repair: effect on postoperative pain: a double-blind, randomized trial versus standard heavyweight mesh. Surgery. 2013;153(1):126-30.

Hidalgo M, Castillo MJ, Eymar JL, Hidalgo A. Lichtenstein inguinal hernioplasty: sutures versus glue. Hernia. 2005;9(3):242-4.

Aasvang E, Kehlet H. Surgical management of chronic pain after inguinal hernia repair. Br J Surgery. 2005;92(7):795-801.

Amid PK. Classification of biomaterials and their related complications in abdominal wall hernia surgery. Hernia. 1997;1(1):15-21.

Katkhouda N. A new technique for laparoscopic hernia repair using fibrin sealant. Surg Technol Int. 2004;12:120-6.

Lau H. Fibrin sealant versus mechanical stapling for mesh fixation during endoscopic extra peritoneal inguinal hernioplasty: a randomized prospective trial. Ann Surg. 2005;242(5):670-5.

Mui WL, Ng CS, Fung TM, Cheung FK, Wong CM, Ma TH, et al. Prophylactic ilioinguinal neurectomy in open inguinal hernia repair: a double-blind randomized controlled trial. Ann Surg. 2006; 244(1):27-33.

Gondal SH, Anwer T, Bhatti AA. A comparative study between Lichenstein and sutureless inguinal mesh hernioplasty. PJMHS. 2013;7(4):940-4.

Ghafoor T, Rehan TM, Amjad S, Waseem M, Anwar MS. Sutureless tension free Lichtenstein repair: a safe option for indirect inguinal hernia. J Sheikh Zayed Med Coll. 2010; 1(3):74-7.

Nordback I. Side incidence of inguinal hernias. Ann Chir Gynaecol. 1984;73(2):87-90.

Lionetti R, Neola B, Dilillo S, Bruzzese D, Ferulano GP. Sutureless hernioplasty with light-weight mesh and fibrin glue versus Lichtenstein procedure: A comparison of outcomes focusing on chronic postoperative pain. Hernia. 2012;16(2):127-31.

Al-Tammimi AS. Sutureless hernioplasty vs Lichtenstein hernioplasty comparative study. Kufa Med J. 2008;11(1):423-9.

Alfieri S, Rotondi F, Di Giorgio A, Fumagalli U, Salzano A, Di Miceli D, et al. Influence of preservation versus division of ilioinguinal, iliohypogastric, and genital nerves during open mesh herniorrhaphy: prospective multicentric study of chronic pain. Ann Surg. 2006;243(4):553-8.