Evolution of Hernioplasty

Dato Dr Mohammad Yusof bin Abdul Wahab

Senior 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

18 Century
th

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

19 Century
th

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

20 Century
th

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