Introduction to Hernia

Repair of inguinal hernia is one of the commonest surgical procedures performed worldwide. The lifetime risk for men is 27% and for women, it is 3 %.

“No disease of the human body, belonging to the province of the surgeon, requires in its treatment, a better combination of accurate, anatomical knowledge with surgical skill than hernia in all its variants.”

Sir Astley Paston Cooper, The Anatomy and Surgical Treatment of Inguinal and Congenital Hernia, Cox, London, 1804.

“I know more than hundred surgeons whom I would cheerfully allow to remove my gallbladder but only one to whom I should like to expose my inguinal canal.”

Sir Henage Ogilvie

History of Hernia Repair

YearProponent and Procedure details
1884Edoardo Bassini
Introduced the modern era of herniorrhaphy.
Bassini’s method relies on a musculoaponeurotic repair to reconstruct the inguinal canal.
1945Edward Earle Shouldice
Four layer repair
1958Francis C. Usher
Used polypropylene as first successful synthetic prosthesis.
1964Irving L. Lichtenstein
Tension free open mesh repair. Till now it is the standard evidence-based operation.
1973Rene Stoppa
GPRVS (Giant Prosthetic Reinforcement of Visceral Sac) / Open preperitoneal mesh repair (Significantly reduced recurrence rate for multi-recurrent groin hernias). He reiterated the advantages of posterior approach.
1982Ralph Ger
The first laparoscopic hernia repair by approximating the internal ring with stainless steel clips.
1992Maurice E. Arregui and Yves Marie Dion TAPP(Transabdominal preperitoneal repair)
1992Ferzli et al., Dulucq, Himpens, and McKernan & Laws, TEP(Total extraperitoneal repair)

Both the techniques of laparoscopic hernia repair reproduce the concept of Stoppa, by placing a large mesh in the preperitoneal space to cover half of the abdominal wall and all the weak areas (Myopectineal orifice of Fruchaud) including area of internal ring, Hasselbach’s triangle and the femoral ring with/without obturator opening. Both TAPP and TEP are now accepted as evidence based treatment for inguinal hernias equivalent to Lichtenstein’s procedure.


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