A modified Lichtenstein technique in the management of female groin hernia: A pilot study

Abstract

AIM: Femoral hernia is associated with a higher complication risk compared to inguinal hernia. Most groin hernia research studies today are performed on men. The Lichtenstein technique is a well-studied, safe, and widely used method in men, but not recommended in women, where the recommended approach is either endoscopic or an open preperitoneal technique.

MATERIALS AND METHODS: A case-control pilot study was performed on adult women with groin hernia repaired using a modified Lichtenstein (ML) technique. The technique is the same as the original Lichtenstein method, with the addition of an incision in the posterior wall of the inguinal canal. If a femoral hernia or weakening is found, a mesh flap is applied to cover the femoral orifice. The primary outcome was perioperative complications, and the secondary outcome was long-term complications.

RESULTS: In this pilot study, 48 women were operated with the ML technique. Only minor perioperative complications were seen, and no serious adverse events occurred. The complications were transient, and no unplanned hospital admission was necessary. No recurrent hernias occurred during the follow-up period, only a few women were dissatisfied with the procedure, and even less reported persisting pain.

CONCLUSION: This ML technique could be an alternative method for female groin hernia repair. This pilot study paves the way for further research and development of this method, which eventually could be used in resource-limited settings or where the surgeon is not specialized in hernia repair.

Keywords

Female groin hernia / mesh repair / modified Lichtenstein technique

References

[1] Bay-Nielsen M , Kehlet H , Strand L , Malmstrøm J , Andersen FH , Wara P , et al; Danish Hernia Database Collaboration . Quality assessment of 26,304 herniorrhaphies in Denmark: A prospective nationwide study. Lancet 2001; 358: 1124- 8.

[2] Burcharth J , Pedersen M , Bisgaard T , Pedersen C , Rosenberg J . Nationwide prevalence of groin hernia repair. PLoS One 2013; 8: e54367.

[3] HerniaSurge Group . International guidelines for groin hernia management. Hernia 2018; 22: 1- 165.

[4] Rosen A , Nathan H , Luciansky E , Orda R . The inguinal region: Anatomic differences in men and women with reference to hernia formation. Acta Anat (Basel) 1989; 136: 306- 10.

[5] Dahlstrand U , Wollert S , Nordin P , Sandblom G , Gunnarsson U . Emergency femoral hernia repair: A study based on a national register. Ann Surg 2009; 249: 672- 6.

[6] Alvarez JA , Baldonedo RF , Bear IG , Solís JA , Alvarez P , Jorge JI . Incarcerated groin hernias in adults: Presentation and outcome. Hernia 2004; 8: 121- 6.

[7] Koch A , Edwards A , Haapaniemi S , Nordin P , Kald A . Prospective evaluation of 6895 groin hernia repairs in women. Br J Surg 2005; 92: 1553- 8.

[8] Köckerling F , Koch A , Lorenz R . Groin hernias in women-a review of the literature. Front Surg 2019; 6: 4.

[9] Henriksen NA , Thorup J , Jorgensen LN . Unsuspected femoral hernia in patients with a preoperative diagnosis of recurrent inguinal hernia. Hernia 2012; 16: 381- 5.

[10] Mikkelsen T , Bay-Nielsen M , Kehlet H . Risk of femoral hernia after inguinal herniorrhaphy. Br J Surg 2002; 89: 486- 8.

[11] Schmidt L , Öberg S , Andresen K , Rosenberg J . Laparoscopic repair is superior to open techniques when treating primary groin hernias in women: A nationwide register-based cohort study. Surg Endosc 2019; 33: 71- 8.

[12] Schouten N , Simmermacher RK , van Dalen T , Smakman N , Clevers GJ , Davids PH , et al. Is there an end of the “learning curve”; of endoscopic totally extraperitoneal (TEP) hernia repair? Surg Endosc 2013; 27: 789- 94.

[13] Dulucq JL , Wintringer P , Mahajna A . Laparoscopic totally extraperitoneal inguinal hernia repair: Lessons learned from 3,100 hernia repairs over 15 years. Surg Endosc 2009; 23: 482- 6.

[14] Simons MP , Aufenacker T , Bay-Nielsen M , Bouillot JL , Campanelli G , Conze J , et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 2009; 13: 343- 403.

[15] Amid PK . Lichtenstein tension-free hernioplasty: Its inception, evolution, and principles. Hernia 2004; 8: 1- 7.

[16] Olsson A , Sandblom G , Fränneby U , Sondén A , Gunnarsson U , Dahlstrand U . The Short-Form Inguinal Pain Questionnaire (sf-IPQ): An instrument for rating groin pain after inguinal hernia surgery in daily clinical practice. World J Surg 2019; 43: 806- 11.

[17] De Gols J , Berkmans E , Timmers M , Vanluyten C , Ceulemans LJ , Deferm NP . Extended Lichtenstein repair for an additional femoral canal hernia. J Clin Med 2024; 13: 5386.

[18] Wang D , Shen Y , Wang F , Chen J , Chen Y , Zhang Y . Mini-mesh and Lichtenstein repair compared with a modified Kugel technique for femoral hernia: A randomised controlled trial. Ann R Coll Surg Engl 2020; 102: 284- 9.

[19] Pangeni A , Shakya VC , Shrestha ARM , Pandit R , Byanjankar B , Rai S . Femoral hernia: Reappraisal of low repair with the conical mesh plug. Hernia 2017; 21: 73- 7.

[20] Kang JS , Qiao F , Nie L , Wang Y , He SW , Wu B . Preperitoneal femoral hernioplasty: An “umbrella” technique. Hernia 2015; 19: 805- 8.

RIGHTS & PERMISSIONS

2025 International Journal of Abdominal Wall and Hernia Surgery | Published by Wolters Kluwer - Medknow on behalf of Higher Education Press