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Editorial Jurnalul de Chirurgie, Iaşi,Vol.
A variant of the Lichtenstein technique consisted via open incision of the preand retromuscular insertion of crema cu hialuronic double-sided prolene mesh, the so-called Prolene Hernia System PHS The idea of repairing a groin hernia from the posterior side, in a preperitoneal position, was already suggested in the 18 th century, anti aging dautel dentist in Bates ? However it got definitely accepted after the proposal of George La Roque in He realized the approach by using an abdominal incision superior to the inguinal canal and, from within the peritoneal cavity, ligaturing the pulled back hernia sac.
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The technique was combined with a Bassini repair via the same cutaneous incision. Moreover opening the peritoneum allowed La Roque to inspect the bowel and other abdominal organs Arnold Henry in was protagonist of an analogous approach, however via a lower abdominal midline incision Alas, both publications received too little attention.
A totally extraperitoneal approach was first executed by Cheatle inas a radical operation for cure of both inguinal and femoral hernia via a lower mid abdominal preperitoneal approach, an incision he preferred for such cure over a Pfannenstiel incision.
Many authors, especially René Stoppa Fig. Equally Amid et al.
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Particularly the Lichtenstein repair is still the first recommended operation for inguinal hernia, not only in the Netherlands see Simons et al. See the European Hernia Society guidelines Simons et al.
Articole de sintez Jurnalul de Chirurgie, Iai,Vol. Trias i colab. Tot n sunt descrise primele aborduri transgastrice Meltzer i Amaral .
See StoppaStoppa et al. The strengthening of the transversalis fascia with prosthetic materialbe it via an external or internal approach, got boosted by new knowledge about the aetiology of direct inguinal hernias.
A deficiency in collagen, resulting from impairment of proline and lysine hydroxylation proved to be the cause of weakening of this fascia, which remains the sole support of the posterior inguinal wall Ralph Ger was the first in to report a transabdominal closure of an inguinal hernia defect during a laparoscopy for other reasons His technique consisted of transfixing with Michel staples the peritoneal hernia sac together with the surrounding tissuesthereby trying to prevent hernia recurrence.
The good results incited Ger to continue on the same track, and to build up experience with experimental work on animals, now inserting the stapler device via a second separate laparoscopic trocar Some years later, inthe gynaecologist S.
Bogojavalensky showed a video demonstrating the laparoscopic intraabdominal incision of the peritoneal hernia sac, subsequently closing the visible muscular defect with a rolled-up piece of polypropylene mesh. Whereas the first interventions were confined to a plug and patch repairlater transabdominal approaches opted for the fixation of a large preperitoneal mesh, either sutured or stapled to the posterior muscular wall A first attempt was made by applying a synthetic mesh to the peritoneal defective wall.
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Another approach consisted in making an intraperitoneal U-type incision in the peritoneal wall and inserting the mesh in a preperitoneal position. Soon other surgeons proposed a complete extraperitoneal insertion of the preperitoneal mesh, namely Dulucq inFerzli et al.
The technique was soon followed by many others. Even a special balloon dissector was introduced to facilitate this extraperitoneal approach Several discussions and symposia followed the introduction of laparoscopic techniques in inguinal hernia repair CorbittBob Fitzgibbons et al.
Indeed, many surgeons worldwide had immediately started their laparoscopic experience on patients, in contrast to various other techniques in surgical practice, anti aging dautel dentist animal experiments precede evaluation in humans.
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Moreover anti aging dautel dentist an era where trials were in common use for new drugs, instruments or techniques, trials in laparoscopy on the contrary were performed scarcely and late, and yielded results only years after the already liberal use of laparoscopy.
When the first trials with often small numbers of patients were published, no real differences in outcome were observed between standard Shouldice or Lichtenstein repairs and laparoscopic techniques However in all trials reduced pain, as well as earlier ambulation and return to work became strongly anti aging dautel dentist These advantages had to counteract the soon observed higher risk of nerve lesion, resulting in so-called meralgia parestheticaand the higher financial costs of the use of laparoscopic apparatus.
In a later stage, many surgeons favoured the extraperitoneal TEP approach, in view of the absence of adhesion risks in the abdomen However, both TAPP and TEP techniques continued to be used in the last 15 years, and are advised as evidence based techniques, equal to Lichtenstein repair A second series of discussions focussed on technical aspects of laparoscopic repair.
So were surgeons concerned about the optimal size or structure of the meshor tried newer forms of cameras, trocars or instruments. As it stands now, as well open techniques with tension free repair type Lichtenstein repairas laparoscopic techniques with preperitoneal mesh placement type TAPP or TEP are the evidence-based and accepted methods in use to deal with adult inguinal hernia It will be interesting to evaluate how these actual types of hernia repair evolve in the future.
Inguinal hernia repair has made enormous progress throughout the ages. Surgical techniques have rapidly evolved since Eduardo Bassini proposed his first successful reconstruction of the inguinal floor.
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The various adaptations of his technique did however not result in a substantial reduction in the number of recurrences. The tension free repair, introduced by Irving Lichtenstein, caused a dramatic drop in the recurrence rate and became the procedure of choice.
The future will tell how hernia repair will evolve in the next decades. The Lichtenstein open tension-free Hernioplasty.
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