The repair of groin hernias; progress in the past decade

British contributions to modern herniology of the groin

Traditional disdain for groin repair stifled recognition of British innovations. Some, relating to modern herniology, are remembered herein. Morton (1841) and Mackay (1889) showed the epigastric artery piercing Cooper's transversalis fascia (1807). Bilaminarity (Cooper, 1807) was confirmed in 1992 (Read). Thomson's iliopubic tract (1838) became part of Nyhus' repair (1960) [derived from McEvedy's repair (1950)] and laparoscopy (Ger, 1982). Retzius' space (Edinburgh, 1858) with Lister's antisepsis (1865) enabled preperitoneal herniorrhaphy (Annandale, 1876). He participated (1873) in intraperitoneal release of incarceration and reducible protrusions (Tait 1883). Cheyne's pectineus muscle plug (1893) preceded Kelly's marble prosthesis for femoral herniation (1898). Cheatle (1920) introduced posterior preperitoneal repair-ignored, rediscovered (Henry, 1936), and adopted (1952) at the Mayo clinic. Calne (1967) pioneered retrorectus Mersilene and was followed by Stoppa (1969) and Wantz (1989). Brandon (1945) blamed failure of modified Bassini's herniorrhaphies on closure at the intermediate inguinal ring instead of the internal. A similar mechanism may explain interstitial recurrence (Gilbert, 2003) after Amid-Lichtenstein repair. Lytle (1896-1986) described a muscle shutter at the internal ring, course of genitofemoral nerve, and orifice of femoral canal. Russell's congenital saccular theory (1906) was questioned by Keith (1924). Acquired connective-tissue pathology was later shown to play a systematic role in adult groin herniation (Read, 1970), confirmed by Jackson and colleagues (1996) and others.

Preperitoneal herniorrhaphy: a historical review

From ancient times, both the transabdominal (posterior) and the groin (anterior) approach have been used either singly or in combination in the management of inguinofemoral herniation. Development accelerated in the nineteenth century after Lister introduced antisepsis. Although Bassini and Halsted conducted their classic procedures in the preperitoneal plane, it was Cheatle, in 1920, who first performed transabdominal preperitoneal herniorrhaphy. In 1950, McEvedy described the lateral approach, which was made popular by Nyhus and Condon in the 1960's. The problem of relaxing incisions and the importance of prosthetic repair through this exposure are substantiated along with the anatomy of the preperitoneal fatty layer and the results of sutureless bilateral herniorrhaphy.

Saddlebag hernia

Saddlebag hernia occurs most commonly as a small indirect sac in association with an obvious direct inguinal hernia. It may be easily overlooked at operation. Hoguet's manoeuvre is the most satisfactory method of operative treatment of saddlebag hernia. It is suggested that an overlooked indirect sac associated with a direct inguinal hernia is a common cause of recurrent inguinal hernia.