Question

Repair done for direct inguinal hernia

• A. Lichtenstein repair
• B. Bassini's repair
• C. Herniotomy
• D. All

Hint:

The surgery of choice for direct inguinal hernia uses a synthetic mesh to avoid tension on the repair.

Answer 1

The Correct Option is A

Step 1: Understand the types of inguinal hernia repair. There are tension-based repairs (Bassini's, Shouldice) and tension-free mesh repairs (Lichtenstein, TEP, TAPP). Herniotomy alone refers to ligation and excision of the sac, used in children -- not adults with direct hernias.

Step 2: Identify the surgery of choice for direct inguinal hernia. Direct inguinal hernia occurs through Hesselbach's triangle due to weakness of the posterior wall of the inguinal canal. It requires reinforcement of the posterior wall.

Step 3: Apply the principle of tension-free repair. Lichtenstein tension-free mesh hernioplasty is the gold standard for direct inguinal hernia in adults. It places a synthetic mesh to reinforce the posterior wall without tension, resulting in the lowest recurrence rate among all repair techniques. Bassini's repair is a tension-based repair with a higher recurrence rate and is not the current surgery of choice.

Conclusion: Lichtenstein repair is the surgery of choice for direct inguinal hernia owing to its tension-free nature and least recurrence rate.