Lichtenstein tension-free hernioplasty: its inception, evolution, and principles.

To circumvent the degenerative nature of inguinal hernias and adverse effect of suture line tension, the Lichtenstein tension-free hernioplasty began in 1984 and evolved (between 1984 and 1988) to a procedure that is now considered the gold standard of hernia repair by the American College of Surgeons. The objective of this paper is to outline the reasons behind the minor changes made during the short, 4-year evolution of the technique, describe the key principles of the operation, and introduce a new mesh that, if elected to be used, automatically satisfies all the key principles of the procedure and guides the surgeon to perform the operation correctly. The worldwide reported result of the operation by experts and nonexperts alike is a recurrence and complication rate of less than 1%. When the key principles of the procedure, which, as reported by many authors, are easy to learn, perform, and teach, are respected, the operation results in an effectiveness (external validation) that is virtually the same as its efficacy (results of the experts), attesting to the simplicity of the procedure.