The History of Inguinal Hernia Surgery & Treatments

DUBAI, UAE, 2021-Oct-05 — /EPR Network/ — Inguinal hernia is a protrusion of abdominal content (intestine, fat, etc,) through a defect in the posterior wall of the inguinal canal. Studies show that 66% of the affected people experience symptoms including pain and discomfort when the abdominal pressure increases. This happens with exercise, heavy lifting, ,straining during bowel movements, coughing, etc. If left untreated for long, a bulging area may occur that grows larger with time and activity. This in turn may complicate with incarceration (inability of the hernia to be pushed back in) or strangulation that is characterized by a compromise of the blood supply and they both need emergency surgery.

With that said, thanks to modern medicine, we now have simpler and less invasive laparoscopic procedures to effectively treat and manage an inguinal hernia. However, the history of the evolution of inguinal hernia goes back to hundreds of years ago. Inguinal hernia and its treatment have been recorded since ancient times (before the 15th century), and was followed by the start of the discipline of herniology (15th to 17th centuries), the anatomic era (17th to 19th centuries), the era of repair under tension (19th to mid 20th century), and the era of tension-free repair (mid 20th century to the present). The modern hernia repair procedures, including open hernia repair, developed across stages such as antiseptic/aseptic hernia operation, high ligation of the sac, tightening of the internal ring, reconstruction of the posterior inguinal floor with sutures, and tensionless repair thanks to the introduction of prosthetic materials (meshes).

“The earliest records of inguinal hernia treatment discuss the use of various types of inguinal belts that were meant to help keep the hernia sac inside the body cavity, ”says Dr. Antonio Privitera, one of Dubai’s leading Proctologists and inguinal hernia specialists. “The hernia was manually reduced, or rather, pushed into the body, following which a custom-made belt was applied.” The use of hernia belts is even found today, to support the bulge from falling out. 

In the 16th century, Italian anatomist Gabriele Falloppio proposed a wide excision of the sac with the surrounding skin and contents of the hernia and securing the neck with a suture. This was the first attempt of a surgical intervention to treat an inguinal hernia. However, it was quickly dismissed as many of the patients were castrated and had a permanent stoma from the intestinal cut, making it an unpopular choice. The procedure also resulted in deaths due to the risk of bleeding and inflammation.

Later on, the introduction of antisepsis and anesthesia allowed the development of much safer procedures. With the help of advanced anatomical knowledge, 19th-century surgeons, notably William Wood, Vinzenz Czerny, and James Heaton applied the rules of high ligation of hernia sac and narrowing of the internal inguinal ring. 

“However, the real breakthrough in hernia treatment is considered to have happened in 1887 and was made by Edoardo Bassini, who realized the need for obliterating the posterior wall of the inguinal canal by approximating with sutures, the inferior borders of the internal oblique and transversus abdominis to the inguinal ligament. Variations of this procedure were followed up until the 20th century.” adds Dr. Privitera.

In 1944, nylon was introduced as a reinforcing material to treat inguinal hernia. This was followed by the use of meshes to hold the protrusion during the hernia surgery, patching the defect. In 1989, Lichtenstein introduced the first tension-free hernioplasty that was the start of all tension-free techniques that followed. 

The introduction of laparoscopy has facilitated the repair of hernias, in particular of bilateral hernias, allowing for reduced postoperative pain and early return to everyday activities. The minimally invasive method called TAPP (transabdominal preperitoneal) technique was reported in 1993, based on the principle of a technique published by Lawson Tait in 1891.

With over 100 years of evolution in the field of inguinal hernia treatment, today, we have two main methods of laparoscopic repairs, namely transabdominal preperitoneal (TAPP) and totally extra-peritoneal (TEP) repair. “Depending upon the patient’s condition and elective/emergency setting, we now offer either open, non-mesh techniques or laparoscopic interventions to treat an inguinal hernia. Use of the mesh, when possible, should be the standard as it is associated with a lower recurrence rate.  Either way, the treatments available today are far more effective and less complicated than what was done back in the early 1990s,” noted Dr. Privitera. 

If you suffer from the symptoms of inguinal hernia, consult with Dr. Antonio Privitera, Proctologist, Colorectal Surgeon, and inguinal hernia specialist at NMC Royal Hospital in Dubai today.