Evolution of Hernioplasty

Dato’ Dr Mohammad Yusof bin Abdul WahabSenior Consultant General Surgeon

Head of Department, HTAR

Greco-Roman Times

Galen Wound surgeon for

gladiators Emperor physician Describe treatment for

inguinal hernia Ligature hernia sac with

spermatic cord Resection of testicle

The Middle Ages

Arabic surgeons Acknowleged that early hernia will reduce

spontaneously Weakening of the peritoneum Treatment → cauterisation of the

peritoneum

The Renaissance

Pierra Franco Describe type of hernia and treatment Scrotal hernia → castration at that side

Ambroise Pare Mostly conservative → strong bandage +

purgetive Surgery if failed conservative treatment Hernia sac separated and tied with golden

thread

18th Century

Anatomy if inguinal canal was extensively studied and understood

First succesful transabdominal repair of inguinal hernia done by Albanian Surgeon Low abdominal incision is made Hernia sac inverted and tied Wound left open

19th Century

Italian surgeon Eduardo Bassini Introduction of anaesthesia

allowed time-consuming dissection at the inguinal canal

Bassini technique was then introduced

Muscular reinforcement of posterior wall

20th Century

Harvey Cushing performed hernia repair under local anaesthesia infiltration

Canadian surgeon Earle Shouldice Hernia repair under LA 4 layer muscular closure of

the posterior wall

Shouldice Repair

Tension Free Repair

Irving Lichtenstein Introduction of prosthetic mesh to bridge

the gap between muscular and ligament tissues

Laparoscopic Inguinal Hernia Repair Ralph Ger

First transabdominal closure of inguinal hernia defect during a laparoscopy for other reason in 1982

Subsequently IPOM TAPP TEP

Thank you