History of Inguinal hernia repair
The history of groin hernia is part of social history. Men have suffered from groin hernia from as long as history has been recorded. Until very recently men with groin hernia had to endure the discomfort and the risk of death related to hernia complications.
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The only real option was some sort of external pressure to stop the hernia from protruding. In working men this must have become impossible. Trus have been used for hundreds of years.
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Trus were manufactured and in common use until the 1960's. They came in a variety of types. Home made constructions were common made of belts or rope with pads. They did work but at a cost. A trus used for years would scar the tissue and make subsequent surgical repair difficult. They did not prevent complications.
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There are records of surgical treatment of hernia dating back to the 3rd century BC. Galen, perhaps the most famous of physicians who lived around 150 AD, described a surgical treatment. This early surgery under minimal anaesthetic suggests the desperate length men went to cure their hernia.
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Prior to safe surgery a strangulated hernia would mean a slow and miserable death.
Open hernia repair has evolved over the last 100 years. Famous surgeons such as Bassini, Shouldice and Stoppa pioneered big changes in the open technique. They were all surgeon anatomists who studied the groin and designed an eponymous repair based on their interpretation of the anatomy.
More recently Lichtenstein from Los Angelos introduced a new groin hernia operation in the 1970's. This used mesh routinely. It did not need the muscles or tendons to be pulled together and was tension free. This open operation became popular in Australia around the year 2000 and is widely used.
History of Keyhole hernia surgery
Reducing an incarcerated groin hernia. It is not clear whether the patient survived.
The recent development of keyhole hernia surgery in the 1990's, is a reflection of several surgeons who contributed and pioneered what is currently the ultimate surgical treatment for groin hernia. Several attempts were made to insert mesh using minimally invasive surgery. This culminated in using the telescope to enter the abdominal cavity and place mesh over the hernia defect (TAP).
Avoiding entering the abdominal cavity became a challenge. The introduction of a totally extraperitoneal approach (TEPP) has revolutionised keyhole minimally invasive hernia surgery. The key to this was the use of a balloon to create a working space for the surgeon.
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By 1995 the relatively high rate of complications with the early experience of keyhole surgery (both TEPP & TAP) gave keyhole hernia surgery a poor name and many surgeons shied away. The approach to the hernia from the inside was radically different to the long history of surgical repairs that had been taught. Surgeons are inherently cautious and sceptical and worried about risk to their patients.
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It has taken a decade for keyhole minimally invasive surgery to mature. It is now a safe but has a significant learning curve.
Medieval trus simlar to those used today
Balloon used for keyhole TEPP hernia repair
Famous hernia surgeons
There are many surgeons who have contributed to the surgery of hernia. Each has built on the experience of others and using their knowledge of anatomy devised improvements in surgical repair. They did not settle for the status quo. They and their patients took risks that we now benefit from.
These pioneers deserve our appreciation. Those with an X chromosome owe them alot.
Bassini - sutures to close the defect. Later modified to a darn, just like darning socks.
Shouldice - introduced a multilayered repair with a lower recurernce rate.
McVay - new sutured repair using Coopers ligament, an anatamical deeper structure but very strong.
McEverty - a lovely open approach to the repair of femoral hernia.
Stoppa - radical approach using mesh at open surgery for large non-fixable hernia.
Lichtenstein - the tension free mesh repair of inguinal hernia.
McKernan - Keyhole repair of inguinal hernia
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Edoardo Bassini 1984 - 1924 https://en.wikipedia.org/wiki/Edoardo_Bassini
'Bassini is remembered for his operative techniques involving inguinal hernia repair. In 1884 he introduced a surgical procedure that allowed for reconstruction of the inguinal canal and restoration of the patient's anatomy following removal of the hernial sac. It was a landmark operation because the posterior wall of the inguinal canal could be rebuilt and reinforced with only surgical sutures. It required no additional reinforcement or prosthesis. Despite the importance of the new surgical method, it didn't become known outside of Italy until 1890' Wikipedia
