Herniology: past, present, and future

Despite herniorrhaphy being performed frequently, most surgeons consider it to be a minor procedure. However, a few surgeons’ views differed.

The Master was Bassini (1884), who introduced a radical cure for inguinal hernia. Incising his triple layer, internal oblique, transversus, and transversalis, he entered the preperitoneal space, allowing high ligation of the sac and mass suturing to the inguinal ligament. A 2.7% recurrence rate evoked worldwide emulation. Corruption ensued. The cremaster remained and few unincised layers were stitched, without imbrications, along with reinforcement using the cremaster or rectus muscles, fascial flaps, relaxing incisions, and silver coils. Little improvement cast doubt on Bassini’s work. Russell’s (Lancet 2:1197–1203, 1906) ligation of the hernial sac was adopted until 1953, when the Shouldice clinic revived Bassini’s tenets, becoming the gold standard for decades. Cheatle (Br Med J 2:68–69, 1920) introduced posterior pre-peritoneal repair. Acquaviva and Bourret (Presse Med 73:892, 1948) designed the first plastic prosthesis (nylon), replaced by polypropylene. Usher (Surg Gynecol Obstet 117:239–240, 1963) parietalized the cord. These contributions paved the way for the Rives, Stoppa, Wantz, and Gilbert repairs, Ger’s laparoscopic approach, and less common herniorrhaphies.

Chevrel (1979) formed the GREPA, which evolved into the European Hernia Society (EHS), joining with the American Hernia Society (AHS) to form the journal ‘Hernia.’ Nilsson (1993) instituted national hernia registries, enabling less recurrences and better prospective research.

In the 21st century, the Lichtenstein procedure has dominated inguinal herniorrhaphy. Herniologists accepted systemic connective tissue disorder as the etiology of abdominal hernia and pelvic prolapses. This malady explains why prostheses slow but do not eliminate recurrence. Antidotes need to be developed and employed.

This malady explains why prostheses slow but do not eliminate recurrence. Antidotes need to be developed and employed.