Abstract:

With a growing understanding of abdominal wall mechanics and improving surgical technology, inguinal herniorrhaphy has undergone significant advancements in the past 100 years. As primary repair through an anterior approach gave way to the "tension-free" Lichtenstein technique in the later part of the 20th century, hernia recurrence rates fell dramatically. With this fall in recurrence rates, other postoperative factors became the measure of herniorrhaphy technique quality. The reductions of postoperative pain and recovery time have become the basis for comparison between techniques. To that end, the plug and patch methods of Millikan and Rutkow, as well as the Kugel memory recoil mesh repair system, adhere to the philosophy of minimal dissection and suturing. The Prolene Hernia System was similarly created to simplify hernia repair while improving postoperative recovery. The posterior approach to hernia fixation was well-described in the late 1800s. Although generally underused, this technique offered an excellent option for repairing all inguinal hernias, especially incarcerated ones. By combining the perspective of preperitoneal repair with laparoscopic technology, a truly novel option for herniorrhaphy was created. Laparoscopy offers lower recurrence and postoperative complication rates than standard primary open repair, with the potential for a faster and more comfortable recovery than the "tension-free" open repair.

Authors:

Daniel D. Klaristenfeld, M.D.; Eric Mahoney, M.D.; David A. Iannitti, M.D., F.A.C.S.

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