Our Summary

This article looks at the history of surgery for inguinal hernias, which are hernias that happen in the groin area. Over time, different methods and materials have been used to fix these hernias. Our understanding of how to effectively and safely repair these hernias improved greatly after Henri Fruchaud published a detailed study of the groin area in 1956.

Italian surgeon Edoardo Bassini started a new chapter in hernia surgery, and his method was used a lot for a long time. A new approach to hernia repair was proposed by Lloyd M. Nyhus in 1959, where the surgeon operates from the front of the abdomen, instead of the traditional way of operating from the back. This new approach was later used to develop a new technique called the transabdominal preperitoneal hernia repair (TAPP).

In 1992, M. Arregui performed the first TAPP using a special type of mesh to support the weakened area. In 1986, Irving Lichtenstein introduced the idea of “tension-free repair”, which means fixing the hernia without putting any strain on the tissues. Based on this concept, Lichtenstein developed a new open technique for hernia repair. This technique is now named after him and is widely used.

In 1993, Edward H. Phillips used the term “extraperitoneal hernia repair” for the first time. However, it was J. Dulucq who developed the modern technique for this type of repair. Today, there are three main types of tension-free hernia repairs (TAPP, TEP, and Lichtenstein procedure) and one type of tension hernia repair (Shouldice procedure) that are most commonly used for inguinal hernia surgeries.

FAQs

  1. What is the history of inguinal hernia repair?
  2. What are the different types of tension-free inguinal hernia repair procedures currently practiced?
  3. Who were the significant surgeons in the development of inguinal hernia repair and what procedures did they introduce?

Doctor’s Tip

One helpful tip a doctor might tell a patient about hernia repair is to follow post-operative care instructions carefully to ensure proper healing and reduce the risk of complications. This may include avoiding heavy lifting, following a proper diet, taking prescribed medications, and attending follow-up appointments with the surgeon. It is important for the patient to communicate any concerns or changes in symptoms to their healthcare provider promptly.

Suitable For

Patients who are typically recommended hernia repair are those who have symptomatic hernias that are causing pain, discomfort, or other complications. Inguinal hernias, in particular, are common in both men and women and may require surgical repair if they are causing symptoms or if they become incarcerated or strangulated. Other types of hernias, such as umbilical hernias or incisional hernias, may also require surgical intervention depending on the severity of the symptoms and the risk of complications. Ultimately, the decision to recommend hernia repair will depend on the individual patient’s specific circumstances and the recommendations of their healthcare provider.

Timeline

  • Before hernia repair: The patient may experience symptoms such as pain, swelling, and discomfort in the area of the hernia. The hernia may protrude through the abdominal wall, causing a visible bulge. The patient may also have difficulty with activities that increase intra-abdominal pressure, such as lifting heavy objects or straining during bowel movements.

  • Hernia repair surgery: The timeline of hernia repair surgery has evolved over time, with different procedures and materials being used at various points in history. The effectiveness and safety of hernia repair improved after the anatomic features of the inguinal region were elucidated in Henri Fruchaud’s monograph in 1956. The Bassini procedure, proposed by Edoardo Bassini, marked a new era in herniology. Lloyd M. Nyhus introduced the concept of the pre-abdominal (posterior) approach in 1959, which later led to the development of the transabdominal preperitoneal hernia repair (TAPP). In 1992, M. Arregui performed the first TAPP using a prolene mesh. Irving Lichtenstein proposed the concept of “tension-free repair” in 1986, leading to the development of the Lichtenstein procedure. In 1993, the term “extraperitoneal hernia repair” was first used by Edward H. Phillips, and J. Dulucq developed the modern TEP technique.

  • After hernia repair: Following surgery, the patient will typically experience some discomfort and soreness in the surgical area. Pain medication may be prescribed to manage any post-operative pain. The patient will need to follow post-operative instructions provided by their surgeon, including restrictions on activities such as lifting, bending, and strenuous exercise. The patient will also need to attend follow-up appointments to monitor their recovery and ensure that the hernia repair was successful.

What to Ask Your Doctor

  1. What type of hernia do I have and what are the options for repair?
  2. What are the risks and complications associated with hernia repair surgery?
  3. What is the expected recovery time after hernia repair surgery?
  4. Will I need to follow any special instructions or restrictions after surgery?
  5. What type of anesthesia will be used during the surgery?
  6. Will I need to stay overnight in the hospital after the surgery?
  7. What are the success rates of the different hernia repair procedures?
  8. How long will the repair last and are there any chances of recurrence?
  9. Are there any alternative treatments to surgery for my hernia?
  10. How many hernia repair surgeries have you performed and what is your success rate?

Reference

Authors: Bulyk I, Shkarban V, Vasyliuk S, Osadets V, Bitska I, Dmytruk O. Journal: Rozhl Chir. 2023 Spring;102(4):149-153. doi: 10.33699/PIS.2023.102.4.149-153. PMID: 37344194