Repeated in vivo inguinal measurements to estimate a single optimal mesh size for inguinal herniorrhaphy

In order to determine the optimal mesh size according to recommended surgical practices, in vivo measurements of key dimensions of the inguinal floor were taken in patients undergoing herniorrhaphy.Measurements were taken in 43 patients: 40 men and 3 women, mean age 43 years (SD 13.6); 39 with indirect hernias, 4 with direct. Allowing for recommended mesh overlaps, the optimal mesh size for provision to be appropriate for the majority of patients was determined to be 8.5 cm x 14.0 cm, 21% wider than the mesh size currently recommended for use in Lichtenstein herniorrhaphy.An appropriate size for routine provision in low-resource settings, or other settings where the provision of several mesh sizes is not supportable, may be 8.5 cm x 14.0 cm.Inguinal hernia is a common condition with a lifetime risk of 27% in men and 3% in women, increasing in both sexes with age. Its repair is one of the most commonly performed surgical procedures in general surgery. Rates of inguinal hernia repair have been reported of 10 per 100,000 of the population for the UK and 28 per 100,000 in the USA [1]. Several operative techniques have been developed to treat inguinal hernias. The Lichtenstein tension-free mesh herniorrhaphy is a widely used technique that has been shown to be effective and to have low recurrence rates [2-5].For each herniorrhaphy case, a surgeon must have on hand a mesh prothesis that will be appropriate. Previous research that has attempted to predict required mesh size pre-operatively according to patients’ body measurements has found no correlation [6]. Thus either a range of products or a single product that can be adapted for each case must be available in the operating room.It has been recommended that a 7.0 x 15.0 cm mesh prostheses is appropriate for the Lichtenstein technique, and that it should trimmed intra-operatively to a suitable size to cover the inguinal floor and provide overlaps along its points of fixation. Research has suggested that providing adequa