CURRENT TREATMENT, RISKS and CONSIDERATIONS IN THE MANAGEMENT OF HERNIAS: An historical approach

Hernias have been a surgical problem since time immemorial. Many of the great names of the surgical arena are attached to advances made in the anatomical understanding and surgical repair. None more so than the Italian anatomist and surgeon Bassini of Padua who in the late 19th century introduced the then radical concept of herniorraphy thus revolutionized hernia repair. Previously only the sac was excised(herniotomy).This was often fatal and rarely cured the hernia. Instead Bassini repaired the defect as well by suturing the muscles of the inguinal canal and their fascia – internal oblique abdominous, transverse abdominous, transversalis fascia and conjoint tendon down to the inguinal ligament. He immediately achieved a high cure and low short term recurrence rate. However over the next century there still remained a high longer term recurrence rate. The technique was more successful with indirect hernias but less so for direct hernias .with direct hernias because the tissues were already much weakened and the repair placed the sutures under tension. The technique endured and was the cornerstone of inguinal repair for over 100 years.