Pure tissue repairs: a timely and critical revival
“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).
KeywordsPure tissue repair Inguinal hernias Polypropylene mesh CPIP (chronic post-inguinal herniorrhaphy pain)
We would like to thank Mr. Eric Frysberg for his able contribution in all matters of data handling.
Compliance with ethical standards
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.
For this type of study, formal consent is not required.
- 2.Iason AH (1940) Hernia. The Blakiston Company, Philadelphia, pp 475–604Google Scholar
- 5.Bendavid R (1987) A femoral umbrella for femoral hernia repair. Surg Gynecol Obstet 65(8):153–156Google Scholar
- 7.Bendavid R (1992) Prosthetics in hernia surgery. A confirmation. Postgrad Gen Surg 4(2):166–167Google Scholar
- 8.Bendavid R (1993) A rational use of mesh in hernia. A perspective. Int Surg 77(4):229–231Google Scholar
- 9.Bendavid R (1994) Prostheses and abdominal wall hernias. RG Landes Company, Austin 9:590Google Scholar
- 12.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):21Google Scholar
- 14.Skandalakis JE (2004) Surgical anatomy. Paschalidi Publications, AthensGoogle Scholar
- 15.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 meetingGoogle Scholar
- 16.Paterson-Brown S, Garden J (1994) Surgical laparoscopy. Cambridge University Press, CambridgeGoogle Scholar
- 17.Muller G, Scheyer M, Zimmerman G (1994) Shouldice-Plastik-Erfahrungen. Acta Chir Austriaca 23(Suppl 110):9Google Scholar
- 24.Fruchaud H (1956) Anatomie chirurgicale des hernies de l’aine chez. DOIN, ParisGoogle Scholar
- 31.Bendavid R (1992) “Dysejaculation”: an unusual complication of inguinal herniorrhaphy. Postgrad Gen Surg 4(2):1992Google Scholar
- 32.Nyhus LM (1995) Hernia, 4th edn. Lippincott, Philadelphia, p 215Google Scholar
- 33.Joseph P (1980) Hernias of the abdominal wall. WB Saunders Co, PhiladelphiaGoogle Scholar
- 34.Devlin HB (1995) Chronic pain after hernia repair. Expert meeting on hernia surgery. Basel-Karger Publication, St Moritz, pp 365–367Google Scholar
- 38.Obney N, Chan CK (1984) Repair of multiple time recurrent inguinal hernias with reference to common causes of recurrence. Contemp Surg 25:25Google Scholar
- 39.Bassini E (1889) Nuovo Metodo Operativo per la Cura Dell’Hernia Inguinale. R. Stabilimento Prosperini, PadovaGoogle Scholar
- 40.Ramshaw B, Jacob BP (2013) Sages manual of hernia repair. Sages, RussellGoogle Scholar
- 41.Ryan John J (2001) The McVay operation in abdominal wall hernias: principles and management. Springer, New York, pp 365–369Google Scholar