Current laparoscopic inguinal hernia repair

Abstract

The inguinal hernia repair developed through advances in anatomy and technique, as did many other surgical procedures. Operations with high mortality and recurrence were the standard until the Bassini repair was popularized in 1889. The Bassini repair, a tissue repair that approximates the inguinal floor, served as the gold standard for herniorrhaphy until modified to the Shouldice repair. Both of these repairs are primary tissue repairs that may result in tension. The development of prosthetics, such as Marlex 50 and improved polypropylene, and the anatomic understanding of the weakness associated with the myopectineal orifice of Fruchaud allowed for the development of a tension-free repair of inguinal hernia defects. The most commonly used is the Lichtenstein repair that involves the use of polypropylene to rebuild the inguinal floor after high ligation of the hernia sac with indirect hernias and replacement into the abdominal cavity with direct hernias. The Lichtenstein repair is a simple operation that can be done with local anesthetic as an outpatient procedure. In fact, it was developed for the office setting. It has a recurrence rate of 1% or less, and it is not associated with the postoperative pain of a primary tissue repair and return to full activity is very rapid, often quoted at less than 5 days. It is difficult for some to imagine how a better repair could be done in the aftermath of the success of the Lichtenstein repair. However, laparoscopic techniques have brought a whole new dimension to many aspects of surgery.