Modern Lichtenstein tension-free mesh repair: step-by-step operative technique

Summary The Lichtenstein tension-free mesh repair remains the most widely applied open technique for primary inguinal hernia repair due to its simplicity, reproducibility, and consistently low recurrence rates. This manuscript provides a structured, contemporary description of the standardized operative method, including patient selection, anesthesia strategies, stepwise dissection, nerve-preserving principles, and evidence-based mesh placement and fixation. Emphasis is placed on precise anatomic exposure, atraumatic cord mobilization, and a tension-free configuration to minimize chronic pain and mesh-related complications. Current evidence and international guidelines continue to support the Lichtenstein repair as the benchmark open approach, demonstrating recurrence and reoperation rates comparable to minimally invasive techniques while maintaining advantages in safety and accessibility across diverse clinical settings.