Introduction
Hernia is defined as an abnormal protrusion of viscus through normal openings in the body. Hernia is a quite common problem of today's civilization. It was very commonly known condition in ancient times too. Before going to the vast intricate details of the hernia and its surgery we will take a brief look at the milestones of hernia surgery. How near perfect surgery has evolved in these recent years and the creditors of this surgery is worth noticing.
- First record of hernia condition: 1500 BC By Greeks.
- First surgery of inguinal hernia: First century AD by Celsus involved excision of sac, testis, chord.
- Paul of Aegina in 700 AD: Complete ligature of sac and cord at external ring (Fig. 1.1).
- Guy de Chauliac in 1363 differentiated inguinal and femoral hernia.
- Franco in 1556 described technique to repair the strangulated hernia to avoid injury to bowel (Fig. 1.2).
- Casper Stromayr 1559 distinguished between direct and indirect hernia.
- Early 19th century correct description of inguinal anatomy.
- Dawn of modern surgery by Joseph Lister 1865 in relation with antiseptic use in surgery (Fig. 1.3).
- Marcy 1871 introduced antiseptic use in hernia surgery.
- Lucas in 1881 opened external oblique aponeurosis and dissected sac.
- Edoardo Bassini 1884 implemented repair of transversalis fascia and reinforcing the posterior wall of inguinal canal with interrupted silk sutures. He is called father of modern hernia surgery. It was a herniorrhaphy surgery (Fig. 1.4).
- George Lotheissen 1898 restructured the inguinal hernia surgery by repairing the femoral ring and inguinal defects.
- McArthur 1901 used pedicle strips of external oblique aponeurosis interlinked between conjoint tendon and inguinal ligament.
- Kirschner 1910 used fascial grafts from thigh.
- Handley 1918 invented “Darn and Staylace” procedure.
- Ogilvie 1937 nonabsorbable silk lattice repair.
- Maingot 1941 advocated Floss silk for darning (Fig. 1.5).
- Melick 1942 used first time Braided, multifilament nylon for inguinal hernia.
- Tanner 1942 Coined the SLIDE operation.
- Shouldice 1953 multilayered repair by Pure tissue repair (Fig. 1.6).
- Usher 1958 first used knitted polypropylene mesh in hernia repair.
- In 1979 first attempt of laparoscopic hernia repair in inguinal region.
- Gilbert 1984 described umbrella plug for inguinal hernia repair.
- Read 1985 described relation between smoking and herniation.
- Lichtenstein 1986 described the tension free repair of inguinal hernias.
- Robbins and Rutkow 1990 coined the concept of introducing preformed mesh plug in hernia defect.
- Schultz 1990 first used a synthetic prosthetic bio-material in laparoscopic repair of an inguinal hernia.
- LeBlanc 1991 describes the attempt of laparoscopic incisional hernia repair.
- Popp 1991 described a method to dissect the peritoneum away from abdominal wall prior to the incision of the peritoneum in TAPP repair.
At a Glance
Theodor Billroth (1878) envisaged prostheses before Bassini's sutured cure (1887) (Fig. 1.7). Phelps (1894) reinforced with silver coils. Metals were replaced by plastic (Aquaviva 1944). Polypropylene (Usher 1962), resisting infection, became popular. Usher instituted tensionless, overlapping preperitoneal repair. Spermatic cord was parietalized, to obviate keyholing. Stoppa (1969) championed the sutureless Cheatle-Henry approach encasing the peritoneum. His technique, “La grande prosthese de renforcement du sac visceral” (GPRVS), was adopted by laparoscopists. Newman (1980) and Lichtenstein (1986) pioneered subaponeurotic positioning. Kelly (1898) inserted a plug into the femoral canal; Lichtenstein and Shore (1974) followed. Gilbert (1987) plugged the internal ring, and Robbins and Rutkow (1993) treated all groin herniae thus. Incisional herniation has been controlled by prefascial, retrorectus prosthetic placement (Rives-Flament 1973). ePTFE (Sher et al. 1980) is useful intraperitoneally, since it evokes few adhesions. Here, laparoscopy (Ger 1982) is competitive. Beginning in 1964 (Wirtschafter and Bentley) experimental and clinical studies have shown herniation may be associated with aging and genetic or acquired (smoking, etc.) systemic disease of connective tissue. These data, with prospective trials, all but mandate tensionless prosthetic repair.
History of the Procedure
Hippocrates used the Greek hernios for bud or bulge to describe abdominal hernias. Statues of the era portray this condition. The Ebers papyrus, from approximately 1550 BCE, detailed the use of a truss. Celsius used transillumination to differentiate a hernia from a hydrocele and advocated gradual pressure (taxis) in the management of incarcerated hernia. The earliest recorded surgical efforts were to reduce the hernia through a scrotal incision, to remove the sac and the testis, and to close the area with sutures that spontaneously extruded.
As the church forbade physicians from surgical procedures, nonphysicians (barbers) began developing therapy for surgical problems. De Chauliac advocated escharotics with gradual cicatrization accompanied by prolonged bed rest as the solution for inguinal hernias. Parë followed the operation of Gerald of Metz using a cerclage wire of gold to retard further intestinal protrusion into the scrotum.
In 1700, Littre reported an omphalomesenteric duct trapped in a hernia. Richter described an incarcerated but nonobstructing hernia in 1785. Hunter, in 1756, detailed the embryological origin of the indirect inguinal hernia. De Gimbernat advocated cutting the ligament that is eponymically associated with him in management of incarcerated femoral hernia. Teale reported the first prevascular femoral hernia in 1846.
Other eponyms associated with inguinal hernias relate to anatomical descriptions by Camper (fascia) (1801), Cooper (ligament) (1804), Cloquet (hernia) (1817), Grynfeltt (hernia) (1866), Hesselbach (triangle) (1814), Laugier (hernia) (1833), Nuck (canal) (1650-1692), Petit (hernia) (1783), and Scarpa (fascia) (1814). Scarpa also previously described a sliding hernia and a Spiegelian hernia in 1645.
The advent of antisepsis by Lister in 1865 paved the way for a more precise surgical approach to hernia. Finally, physicians could expect success of an operation not being disrupted by infection. In 1871, Marcy felt that closure of the fascia adjacent to the internal ring would provide a reliable repair of the inguinal hernia. Over a decade later, Bassini (1884) formulated an approach to hernia repair that remains the foundation of the modern hernia repair, namely, reconstruction of the floor of the inguinal canal. In the last century, Cheatle used a properitoneal approach in 1920, while McVay (1948) made popular the use of Cooper's iliopectineal ligament in repair.