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Abstract
Surgical repair of the hernia is considered to be the only definitive management of hernia.
The outcome of hernia surgery is highly surgeon dependent ”no disease of the human body, belonging to the province of surgeons requires in its treatment a greater combination of accurate anatomical knowledge with surgical skill than hernia in all its varieties”.
The exact cause of inguinal hernia is still unknown but the following factors contribute in its occurrence.
A preformed congenital sac, raised intraabdominal pressure and weak abdominal musculature.
There is no ”gold standard” operation for treatment of inguinal hernias.
The optimal surgical approach must be selected individually for the patient, taking into account patient age, hernia size, unilaterality or bilaterality, primary or recurrent status, type of anesthesia, occupation, and patient activities.
There are three important landmarks in the history of repair of inguinal hernia:
1. Tissue repair (Eduardo Bassini 1887).
2. Onlay mesh (Irving Lichtenstein1984) ,tension-free repair.
3. Laparoscopic hernia repair (1990).
In 1887, Bassini published his original description of inguinal hernia repair.
Later on, many modern modifications such as the Shouldice repair and the Lichtenstein ”tensionless” mesh repair have originated from it.
Within a decade in the 1990s, laparoscopic enthusiasts had already described three forms of laparoscopic repairs, namely: the intraperitoneal mesh (IPOM) repair, the trans-abdominal preperitoneal repair (TAPP), and the totally extraperitoneal (TEP) repair.
Laparoscopic inguinal hernia repairs, especially total extraperitoneal(TEP) inguinal hernia repair, have gained ground in the past few years. TEP is preferred over TAPP as it is less invasive and preserves the ”peritoneal sanctity”.
Prospective randomized trials comparing TEP with open Lichtenstein repair have shown TEP as a better alternative than open repair in terms of lesser postoperative pain, earlier ambulation, earlier return to work and better cosmetic results.
However, TEP has a longer and steeper learning curve due to the ”inside out anatomical view”, to which the surgeon is not accustomed.
The recurrence rate for TEP is lower than that for conventional suture herniorrhaphy, but no studies have yet demonstrated a lower recurrence rate after TEP than after Lichtenstein hernioplasty for unilateral primary inguinal hernia.
The chief reason for early recurrence after inguinal hernia repair,with either TEP or Lichtenstein hernioplasty, is technical or surgeon factors.