Inguinal / Femoral Hernia Repair

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Evolution of Inguinal / Femoral Hernia Repair

Groin hernia management was first described in medical writings by the ancient Egyptians. Early repairs were attempted with little understanding of the complex anatomy in the groin region and were greatly unsuccessful. With increased understanding of anatomy and advancement of aseptic techniques and anesthetic principles, the management of groin hernias evolved.

Surgical repair now involves both the reduction of the herniated contents back into the abdomen, as well as tension-free correction and/or reinforcement of the defect in the abdominal wall. Many techniques exist for the repair of groin hernias, including: the Shouldice, the Bassini, the McVay, and the Lichtenstein repair.

The techniques mentioned above are considered open procedures, requiring an incision in the groin to access the hernia sac. Once the hernia contents are reduced, the defect in the body wall is either repaired by sewing it closed with suture (primary repair) or by covering it with mesh (patch repair).

Today, the leading technique for open inguinal hernia repair is the Lichtenstein procedure, a tension-free repair utilizing the placement of inguinal hernia mesh to correct the defect in the abdominal wall. Less invasive laparoscopic and robotic options also exist, and include the TEP (Totally Extraperitoneal) and TAPP (Transabdominal Preperitoneal) approaches.

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