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Biomedical subjects

I L Lichtenstein

Publications and source records attributed to I L Lichtenstein.

At least 19 recordsLinked to original sources
PubMed1997

[Current assessment of Lichtenstein tension-free hernia repair].

The tension-free hernioplasty project began in 1984 at the Lichtenstein Hernia Institute. The method consists of complete reinforcement of the inguinal floor with a large sheet of mesh, with adequate mesh tissue interface beyond the boundary of the inguinal floor, and creation of a new internal ring made of prosthesis. The preliminary report on this operation was published in 1989, with no recurrence at that point in time. Shortly after submission of the report, several recurrences were encountered. Based on the lesson learned from those recurrences, the operation was slightly modified and reported in 1991. Since then, the Lichtenstein technique has gained world-wide popularity. Outcome measures identical to ours and other authors have been achieved by even those surgeons who have no special interest or expertise in herniology. The purpose of this article is to report the current state of the open tension-free hernioplasty for the repair of primary and recurrent inguinal hernias.

Adult↗
PubMed1996

Simultaneous repair of bilateral inguinal hernias under local anesthesia.

OBJECTIVE: The authors confirm the advantages of simultaneous repair of bilateral inguinal hernias, indicate that it is feasible to perform the procedure under local anesthesia, and suggest that when an open tension-free technique is used, the results are superior to those of laparoscopic repair of bilateral inguinal hernias. SUMMARY BACKGROUND DATA: Between 1971 and 1995, simultaneous repair of bilateral inguinal hernias were performed in 2953 men. Initially, between 1971 and 1984, patients with indirect hernias underwent the traditional tissue approximation repair. Those with direct hernias had the same procedure, with the repair additionally buttressed by a sheet of Marlex mesh (Davol, Inc., Cronston, RI). Between 1984 and 1995, both direct and indirect hernias were repaired using the open tension-free hernioplasty procedure. METHOD: The 2953 patients underwent simultaneous repair of bilateral inguinal hernias under local anesthesia in a private practice setting in general hospitals. RESULTS: In those cases in which the "tension free" technique was used, patients experienced minimal to mild postoperative pain and had a short recovery period, with a recurrence rate of 0.1%. CONCLUSIONS: Uncomplicated bilateral inguinal hernias in adults are best treated simultaneously. It is feasible to perform the operation under local anesthesia, and when an open tension-free repair is used, postoperative pain and recovery periods are equally comparable with those of laparoscopic repair, although the complication and the recurrence rates are significantly less.

Adult↗
PubMed1996

[Retromuscular alloplasty of large scar hernias: a simple staple attachment technique].

This article introduces a stapling technique which is a simpler, faster and safer method of performing the Stoppa procedure. It also encourages use of preperitoneal repair instead of the often unsuccessful onlay mesh repair. The latter repair involves placing the mesh over the abdominal aponeurotic layer and can result in a high incidence of infection, seroma accumulation, and chronic fibrous cyst formation. In the preperitoneal repair technique, the same force that created the hernia--the intra-abdominal hydrostatic pressure--keeps the mesh tightly in place and prevents recurrence of the hernia. In 29 of the 75 patients, the mesh was fixed in place with hand suturing. In the other 46, staplers attached the mesh. The authors have found the stapling technique to be both simpler to accomplish and safer for the patient.

Adult↗
PubMed1996

Open "tension-free" repair of inguinal hernias: the Lichtenstein technique.

OBJECTIVE: To report our results with an open, tension free technique of repairing primary inguinal hernias using polypropylene (Marlex) mesh under local anaesthesia. DESIGN: Open study. SETTING: Specialist clinic, USA. SUBJECTS: 3480 Out of a total of 4000 men whose primary inguinal hernias were repaired between June 1984 and June 1995. INTERVENTIONS: Hernia repair involving total reinforcement of the transversalis fascia with mesh. MAIN OUTCOME MEASURE: Morbidity, particularly recurrence. RESULTS: A total of 1776 (44.4%) were direct hernias, 1724 (43.2%) indirect, and 500 (12.5%) a combination; 456 (11.4%) were sliding hernias. Patients were followed up for a mean of 51/2 years (range 1-11) and 520 were lost to follow-up, leaving 3480 (87.0%) for analysis. All patients followed up were examined by a physician. There were five recurrences (0.1%), four at the pubic tubercle and one in which the mesh had torn away from the inguinal ligament because it was too narrow. There has been one recurrence in the last six years of the study. One patient developed orchitis. There was one case of postoperative neuralgia. There were no seromas that required aspiration. Most patients had returned to work within two weeks, including the manual workers. CONCLUSION: Repair of primary inguinal hernias under local anaesthesia with the open, tension-free technique using polypropylene mesh results in acceptable morbidity, and appreciable reductions in postoperative discomfort, duration of hospital stay, recurrence rate and costs.

Adult↗
PubMed1995

The Lichtenstein open "tension-free" mesh repair of inguinal hernias.

All standard methods of hernia repair involve suturing together tissues which are not normally in apposition. This violates the basic surgical principle that tissue must never be approximated under tension and thus accounts for an unacceptable number of failures. A total reinforcement of the inguinal floor with a sheet of suitable biomaterial and the employment of a "tension-free" technique is a more effective approach. Since June 1984, 4,000 primary inguinal hernias have been repaired on an outpatient basis and under local anesthesia at the Lichtenstein Hernia Institute by the open "tension-free" technique using Marlex mesh. The patients were followed from 1 to 11 years by physician examination. The follow-up rate was 87%. There were four recurrences. The causes of recurrence and how to avoid them are herein discussed. Three of the recurrences occurred at the pubic tubercle and were caused by placing the mesh in juxtaposition to the tubercle. This error has since been corrected by overlapping the mesh at the pubic bone. One recurrence was caused by a disruption of the lower edge of the mesh from the shelving margin of Poupart's ligament. The error here was the utilization of a patch that was too narrow and therefore under tension. It became apparent that a wider patch, fixed in place with an appropriate degree of laxity, was required.

Adult↗
PubMed1995

[Biomaterials and hernia surgery. Rationale for using them].

UNLABELLED: A study was made of the distinct biomaterials used in surgery and the requirements to be fulfilled and principles applied for their use in the repair of abdominal wall hernias. The biomaterials most frequently used in hernia surgery are: politetrafluorethylene (PTFE) sheet (Gore-Tex), the multifilament PTFE mesh (Teflon), the multifilament polypropylene mesh (Surgipro), the mono-filament polypropylene mesh (Marlex), the double filament polypropylene mesh (Prolene) and the multi-filament polyester mesh (Mersilene). Requirements for use in hernia surgery: the material must be inert, permanent and non-reabsorbable, resistant to infection, becomes rapidly fixed and incorporated into the host tissues, and not adhere to abdominal viscera. Principles for use: based on the overlapping of the mesh with the aponeurotic plane such that abdominal pressure aids fixation to this plane; contact with abdominal viscera must be avoided. CONCLUSIONS: based on the published experimental and clinical experience of the authors and other researchers, polypropylene is judged to be the most appropriate material for the repair of abdominal hernias.

Biocompatible Materials↗
PubMed1995

[Lichtenstein's "tension-free" operation for inguinal hernia under local anesthesia].

Lichtenstein's technique for surgical cure of primary inguinal hernia using local anaesthesia is described. Since 1984, 3250 primary hernia operations were performed at the Lichtenstein Hernia Institute. There were 4 recurrences due to technical errors which are described. This tension-free technique is a reliable, simple and effective procedure. Patients return to normal activity within 2 to 14 days. Studies one 22300 operations performed by several surgeons produced similar results for post-operative recurrence and complications.

Anesthesia, Local↗
PubMed1995

Mesh between the oblique muscles is simple and effective in open hernioplasty.

Controversy exists as to the best position for insertion of the mesh patch in open inguinal herniorrhaphy. The "inlay" mesh graft, which is laid under the transversalis fascia, has been considered preferable by some authors. But in the Lichtenstein open tension-free inguinal hernia repair, the mesh is preferably placed under the external oblique aponeurosis. It is not an "onlay graft" because it lies under the external oblique and over the internal oblique muscles and transversalis fascia. The possible development of an "interstitial" hernia is without basis and has never been seen. This particular "onlay graft" (more correctly an intermuscular graft) is much simpler to apply and has resulted in almost no recurrences and side effects. Placing the patch between the two oblique muscles is therefore recommended for open tension-free primary inguinal hernioplasties.

Hernia, Inguinal↗
PubMed1995

Biomaterials for "tension-free" hernioplasties and principles of their applications.

Although decreasing, there exists an unjustified fear of mesh for the repair of inguinal and incisional hernias. This is due to the negative experience of the past when ideal biomaterials were not available. At the time of introduction of Marlex mesh by Francis Usher, three decades ago, ideal suture material for fixation of the mesh was not available and created undesirable complications. This compounded the fear of mesh for the repair of abdominal wall hernias. With the variety of prosthetic and suture materials available today, the importance of biomaterials in abdominal wall hernia surgery is increasingly appreciated. The purpose of this paper is to discuss some important requirements of ideal biomaterials and principles of their surgical application.

Animals↗
PubMed1995

The Lichtenstein open "tension-free" mesh repair of inguinal hernias.

All standard methods of hernia repair involve suturing together tissues which are not normally in apposition. This violates the basic surgical principle that tissue must never be approximated under tension and thus accounts for an unacceptable number of failures. A total reinforcement of the inguinal floor with a sheet of suitable biomaterial and the employment of a "tension-free" technique is a more effective approach. Since June of 1984, 4,000 primary inguinal hernias have been repaired on an outpatient basis and under local anesthesia at the Lichtenstein Hernia Institute by the open "tension-free" technique using Marlex mesh. The patients were followed from one to 11 years (mean of 5 years) by physician examination. The follow-up rate was 87%. There were four recurrences. The causes of recurrence and how to avoid them are discussed herein. Three of the recurrences occurred at the public tubercle and were caused by placing the mesh in juxtaposition to the tubercle. This error has since been corrected by overlapping the mesh at the public bone. One recurrence was caused by disruption of the lower edge of the mesh from the shelving margin of Poupart's ligament. The error here was the utilization of a patch that was too narrow and therefore under tension. It became apparent that a wider patch, fixed in place with an appropriate degree of taxity, was required.

Adult↗
PubMed1994

Experimental evaluation of a new composite mesh with the selective property of incorporation to the abdominal wall without adhering to the intestines.

This preliminary study examined the possibility of preventing intestinal adhesions to biomaterials while preserving their incorporation with the abdominal wall. White New Zealand rabbits received intraperitoneal implants of different biomaterials for repair of defects created on the abdominal wall. The following biomaterials were used: polypropylene, polyester, expanded polytetraflueroethylene, polypropylene mesh/polypropylene sheeting (polypropylene mesh covered with polypropylene sheeting on the peritoneal side), polypropylene/silastic, polypropylene/polyglactin, polypropylene/polyglycolic acid, and polypropylene/fibrin. All biomaterials evaluated caused adhesions to the intestines except for polypropylene mesh/polypropylene sheeting and polypropylene mesh/silastic composites. Because adhesion of the intestine to the biomaterial is the first stage of biomaterial-related intestinal fistula, its prevention is logical for the elimination of this complication. Composites with the selective property of adhering to the abdominal wall, yet sparing the viscera, would facilitate thoracic and abdominal wall surgeries, as well as intraperitoneal laparoscopic hernioplasties.

Abdominal Muscles↗
PubMed1994

Biomaterials for abdominal wall hernia surgery and principles of their applications.

This article focuses special attention on the porosity, cellular permeability and molecular permeability of biomaterials and their effect on infection, host tissue incorporation and seroma formation when mesh is used for the repair of abdominal wall hernias. Furthermore, the general principles of the application of biomaterials, regardless of the technique used for their employment, is discussed.

Abdominal Muscles↗
PubMed1994

Patch or plug for groin hernia--which?

Prosthetic mesh is becoming widely used in the management of both primary and recurrent groin hernias. Confusion exists as to when to choose which of the two popular forms: patch or plug. Here are presented the indications for each type of tension-free hernia repair based on the experience of over 20 years in the exclusive surgery of groin hernias.

Adult↗
PubMed1994

Local anesthesia for inguinal hernia repair step-by-step procedure.

OBJECTIVE: The authors introduce a simple six-step infiltration technique that results in satisfactory local anesthesia and prolonged postoperative analgesia, requiring a maximum of 30 to 40 mL of local anesthetic solution. SUMMARY BACKGROUND DATA: For the last 20 years, more than 12,000 groin hernia repairs have been performed under local anesthesia at the Lichtenstein Hernia Institute. Initially, field block was the mean of achieving local anesthesia. During the last 5 years, a simple infiltration technique has been used because the field block was more time consuming and required larger volume of the local anesthetic solution. Furthermore, because of the blind nature of the procedure, it did not always result in satisfactory anesthesia and, at times, accidental needle puncture of the ilioinguinal nerve resulted in prolonged postoperative pain, burning, or electric shock sensation within the field of the ilioinguinal nerve innervation. METHODS: More than 12,000 patients underwent operations in a private practice setting in general hospitals. RESULTS: For 2 decades, more than 12,000 adult patients with reducible groin hernias satisfactorily underwent operations under local anesthesia without complications. CONCLUSIONS: The preferred choice of anesthesia for all reducible adult inguinal hernia repair is local. It is safe, simple, effective, and economical, without postanesthesia side effects. Furthermore, local anesthesia administered before the incision produces longer postoperative analgesia because local infiltration, theoretically, inhibits build-up of local nociceptive molecules and, therefore, there is better pain control in the postoperative period.

Anesthesia, Local↗