Abstract
“The majority of hernias can be satisfactorily repaired by using the tissues at hand. The use of mesh prosthesis should be restricted to those few hernias in which tension or lack of good fascial structures prevents a secure primary repair. This group includes large direct inguinal hernias and incisional hernias in which the defect is too large to close primarily without undue tension. Most recurrent hernias, because of this factor are best repaired with mesh prosthesis”. These words, penned in 1960 by Francis Usher have reconfirmed what had been a mantra of the Shouldice Hospital (Usher in 81:847–854, 1960). The Shouldice Hospital has specialized in the treatment of abdominal wall hernias since 1945. It has, since its beginning, insisted on the fact that a thorough knowledge of anatomy coupled with large volumes of surgical cases would lead to unparalleled expertise. It was Cicero who taught us that “Practice, not intelligence or dexterity, will win the day”! Since the seminal contribution of Bassini (1844–1924), there have been no less than 80 procedures imitating his inguinal herniorrhaphy and much more since the introduction of mesh and mesh devices (Iason in Hernia. The Blakiston Company, Philadelphia, pp 475–604, 1940). All have failed to some extent and it appears that the common denominator for these failures was the inability to understand the importance of entering the preperitoneal space. Only Shouldice and McVay (Lotheissen, Narath) realized the shortcoming and have continued to thrive as a successful procedure. Entering the preperitoneal space eliminates any temptation to plicate the posterior inguinal wall, a layer normally deficient in direct inguinal hernias, but it also allows the identification of muscle layers rectus, transversus and internal oblique muscles which will go to reconstruct the posterior inguinal wall, without tension as reported by Schumpelick (Junge in 7(1):17–20, 2003).
Similar content being viewed by others
Change history
06 August 2019
In the original publication, author group, abstract text, position of Figure 1, Figure 5 legend, Figure 6 (duplication of figure panels) and the conflict of interest statement were incorrectly published. The corrected text and the figures are given here.
References
Usher F, Cogan JE, Lowry TI (1960) A new technique for the repair of inguinal and incisional hernias. Arch Surg 81:847–854
Iason AH (1940) Hernia. The Blakiston Company, Philadelphia, pp 475–604
Junge K, Peiper C, Schachtrupp A, Schumpelick V (2003) Breaking strength and tissue elasticity after Shouldice repair. Hernia 7(1):17–20 (Epub 2003 Jan 15)
Bendavid R (1986) The, “Fletching”: a new implant for the treatment of inguino-femoral hernias. Int Surg 71(4):248–251
Bendavid R (1987) A femoral umbrella for femoral hernia repair. Surg Gynecol Obstet 65(8):153–156
Bendavid R (1997) Composite mesh (polypropylene-e-PTFE) in the intraperitoneal position. A report of 30 cases. Hernia 1:5–8
Bendavid R (1992) Prosthetics in hernia surgery. A confirmation. Postgrad Gen Surg 4(2):166–167
Bendavid R (1993) A rational use of mesh in hernia. A perspective. Int Surg 77(4):229–231
Bendavid R (1994) Prostheses and abdominal wall hernias. RG Landes Company, Austin 9:590
Bendavid R, Iakovlev V et al (2016) A mechanism of post-herniorrhaphy neuralgia. Hernia 20(3):357–365
Iakovlev V, Bendavid R (2018) A pathology of mesh and time. Ann Surg 267:569–575
Bendavid R, Lou W, Koch A, Iakovlev V et al (2014) Mesh-related SIN syndrome. A surreptitious irreversible neuralgia and its morphologic background in the etiology of post-herniorrhaphy pain. Int J Clin Med 5(13):21
Bischoff JM, Linderoth G, Aaswang EK, Werner MU, Kehlet H (2012) Dysejaculation after laparoscopic inguinal herniorrhaphy. Surg Endosc 26(4):979–983
Skandalakis JE (2004) Surgical anatomy. Paschalidi Publications, Athens
Rodrigues AJJR, Rodrigues CH, Terra R, Popler C (1998) Anatomical study of venous architecture at the space of Bogros by preperitoneal approach. In: Department of Surgery, Faculty of Medicine, University of Sao Paolo, Brazil in American Association of Clinical Anatomists, 15th annual meeting
Paterson-Brown S, Garden J (1994) Surgical laparoscopy. Cambridge University Press, Cambridge
Muller G, Scheyer M, Zimmerman G (1994) Shouldice-Plastik-Erfahrungen. Acta Chir Austriaca 23(Suppl 110):9
Junge K, Peiper C, Rosch R, Lynen P, Schumpelick V (2002) Effect of tension induced by Shouldice repair on postoperative course and long-term outcome. Eur J Surg 168(6):329–333. https://doi.org/10.1080/11024150260284824
Peiper C, Junge K, Füting A, Bassalaý P, Conze J, Schumpelick V (2001) Inguinal tensile strength and pain level after Shouldice repair. Hernia 5(3):129–134
Schippers E, Peiper C, Schumpelick V (1996) Pro-Shouldice: primary tension-free hernia repair—conditio sine qua non? Swiss Surg 4:33–36
Murphy BL, Ubl DS, Paley K et al (2018) Trends of inguinal hernia repairs performed for recurrence in the United States. Surgery 163(2):343–350. https://doi.org/10.1016/j.surg.2017.08.001 (Epub 2017 Sep 15)
Malik A, Bell CM, Stukel TA, Urbach DR (2016) Recurrence of inguinal hernias repaired in a large hernia surgical specialty hospital and general hospitals in Ontario. Can J Surg 59(1):19
Ramjist JK, Dossa F, Stukel TA, Urbach DR, Fu L, Baxter NN (2018) Reoperation for inguinal hernia recurrence in Ontario: a population-based study. Hernia. https://doi.org/10.1007/s10029-018-1822-0 (Epub ahead of print)
Fruchaud H (1956) Anatomie chirurgicale des hernies de l’aine chez. DOIN, Paris
The HerniaSurge Group (2018) International guidelines for groin hernia management. Hernia 22(1):1–165
Bay-Nielsen M, Perkins FM, Kehlet H, Danish Hernia Database (2001) Pain and functional impairment 1 year after inguinal herniorrhaphy: a nationwide questionnaire study. Ann Surg 233(1):1–7
Page B, Paterson C, Young D, O’Dwyer PJ (2002) Pain from primary inguinal hernia and the effect of repair on pain. Br J Surg 89(6):809
Poobalan AS, Bruce J, Smith WC, King PM, Krukowski ZH, Chambers WA (2003) A review of chronic pain after inguinal herniorrhaphy. Clin J Pain 19(1):48–54 (PMID:12514456)
Aasvang E, Kehlet H (2005) Chronic postoperative pain: the case of inguinal herniorrhaphy. Br J Anaesth 95(1):69–76 (Epub 2004 Nov 5)
Fränneby U, Sandblom G, Nordin P et al (2006) Risk factors for long-term pain after hernia surgery. Ann Surg 244(2):212–219
Bendavid R (1992) “Dysejaculation”: an unusual complication of inguinal herniorrhaphy. Postgrad Gen Surg 4(2):1992
Nyhus LM (1995) Hernia, 4th edn. Lippincott, Philadelphia, p 215
Joseph P (1980) Hernias of the abdominal wall. WB Saunders Co, Philadelphia
Devlin HB (1995) Chronic pain after hernia repair. Expert meeting on hernia surgery. Basel-Karger Publication, St Moritz, pp 365–367
Iakovlev V, Koch A, Petersen K, Morrison J, Grischkan D, Oprea V, Bendavid R (2018) A pathology of mesh and time. Dysejaculation, sexual pain, and orchialgia resulting from polypropylene mesh erosion into the spermatic cord. Ann Surg 267(3):569
Nguyen DK, Amid PK, Chen DC (2016) Groin pain after inguinal hernia repair. Adv Surg 50:203–220
Alfieri S, Amid PK, Campanelli G et al (2011) International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery. Hernia 15:239–249. https://doi.org/10.1007/s10029-011-0798-9
Obney N, Chan CK (1984) Repair of multiple time recurrent inguinal hernias with reference to common causes of recurrence. Contemp Surg 25:25
Bassini E (1889) Nuovo Metodo Operativo per la Cura Dell’Hernia Inguinale. R. Stabilimento Prosperini, Padova
Ramshaw B, Jacob BP (2013) Sages manual of hernia repair. Sages, Russell
Ryan John J (2001) The McVay operation in abdominal wall hernias: principles and management. Springer, New York, pp 365–369
Acknowledgements
We would like to thank Mr. Eric Frysberg for his able contribution in all matters of data handling.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
No conflict of interest to declare on the part of the participating authors.
Human and animal rights
This article does not contain any studies with human participants or animals performed by any of the authors.
Informed consent
For this type of study, formal consent is not required.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
The article is part of the Topical Collection “Forum on primary monolateral uncomplicated inguinal hernia”.
Vladimir Iakovlev consulted for pathology.
Rights and permissions
About this article
Cite this article
Bendavid, R., Mainprize, M. & Iakovlev, V. Pure tissue repairs: a timely and critical revival. Hernia 23, 493–502 (2019). https://doi.org/10.1007/s10029-019-01972-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10029-019-01972-2