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ANZ Journal of Surgery, 2009
Herniae have been documented since ancient times, but the era of modern hernia treatment is accep... more Herniae have been documented since ancient times, but the era of modern hernia treatment is accepted as starting with the surgery of Bassini. Suture repairs of various types then dominated the treatment of hernia until the era of mesh repair championed by Stoppa and Lichtenstein. Surgeons feel that mesh repairs have revolutionized hernia surgery. Have the mesh repairs really made such a difference? There is evidence that all is not as it seems! Published recurrence figures don't seem to withstand close scrutiny. One of the trendy terms in herniology is the "myo-pectineal orifice", while many hernia specialists pay lip service to this concept, very few available hernia operations address this problem. The latest area of interest in the world of hernia surgery is the area of posthernia groin pain, either neuralgic or non-neuralgic. There are studies showing an incidence of chronic groin pain following anterior repairs of 30% or more, and yet these operations are the most common hernia operations in the world! Keith in 1924 first postulated the concept of herniosis and was criticized. However there is a large volume of convincing evidence that herniae are manifestations of a metabolic disorder. They are associated with abdominal aortic aneurysm and possibly with such diverse conditions as diverticular disease, cholelithiasis, and perhaps haemorrhoidal disease. Are we there yet? The answer is certainly no. However research into the metabolic problem of hernia development means that we are surely closer than we have ever been before.
ANZ Journal of Surgery, 2009
Herniae have been documented since ancient times, but the era of modern hernia treatment is accep... more Herniae have been documented since ancient times, but the era of modern hernia treatment is accepted as starting with the surgery of Bassini. Suture repairs of various types then dominated the treatment of hernia until the era of mesh repair championed by Stoppa and Lichtenstein. Surgeons feel that mesh repairs have revolutionized hernia surgery. Have the mesh repairs really made such a difference? There is evidence that all is not as it seems! Published recurrence figures don't seem to withstand close scrutiny. One of the trendy terms in herniology is the "myo-pectineal orifice", while many hernia specialists pay lip service to this concept, very few available hernia operations address this problem. The latest area of interest in the world of hernia surgery is the area of posthernia groin pain, either neuralgic or non-neuralgic. There are studies showing an incidence of chronic groin pain following anterior repairs of 30% or more, and yet these operations are the most common hernia operations in the world! Keith in 1924 first postulated the concept of herniosis and was criticized. However there is a large volume of convincing evidence that herniae are manifestations of a metabolic disorder. They are associated with abdominal aortic aneurysm and possibly with such diverse conditions as diverticular disease, cholelithiasis, and perhaps haemorrhoidal disease. Are we there yet? The answer is certainly no. However research into the metabolic problem of hernia development means that we are surely closer than we have ever been before.