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1. A proficient understanding of groin anatomy is essential to successful inguinal hernia treatment.

2. Conservative management of asymptomatic inguinal hernias is acceptable.

3. Elective repair of inguinal hernias can be undertaken using a laparoscopic or open approach.

4. Laparoscopic inguinal hernia repair results in less pain and faster recovery, yet requires specialized training and equipment.

5. The use of prosthetic mesh as a reinforcement significantly improves recurrence rates, whether the repair is open or laparoscopic.

6. Recurrence, pain, and quality of life are important outcome factors.

The treatment of inguinal hernias is integral to the history and current status of general surgery; evolution in the treatment of inguinal hernias has paralleled technologic developments in the field. The most significant advances to impact inguinal hernia repair have been the addition of prosthetic materials to conventional repairs and the introduction of laparoscopy to general surgical procedures.

Evidence of surgical repair of inguinal hernias can be traced back to civilizations of ancient Egypt and Greece.1 Early management of inguinal hernias involved a conservative approach using trusses; however, the inefficacy of this approach prompted the initiation of a surgical approach to the problem. As a consequence of the primitiveness of the techniques, the treatment was often worse than the disease itself. Surgery often involved routine excision of the testicle, and wounds were closed with cauterization or left to granulate on their own. Considering these procedures were performed before the advent of the aseptic technique, it is safe to assume that mortality was quite high. For those that did survive the operation, recurrence of the hernia was commonplace.

Failure of these early techniques of hernia repair was based on inadequate knowledge of groin anatomy and poor understanding of the natural history of hernia formation. As the anatomy of the human body was described via dissection study, the anatomy of the groin became defined. From the late 1700s to the early 1800s, physicians such as Hasselbach, Cooper, Camper, Scarpa, Richter, and Gimbernat identified vital components of the inguinal region, and their contributions are reflected in the current nomenclature. The progress in anatomic understanding, coupled with the development of the aseptic technique, led surgeons such as Marcy, Kocher, and Lucas-Championnière to enter the inguinal canal and perform sac dissection, high ligation, and closure of the internal ring. Results had improved, but recurrence rates remained high with prolonged follow-up.

By demonstrating a comprehensive understanding of inguinal anatomy, Bassini (1844–1924) transformed inguinal hernia repair into a successful venture with minimal morbidity to the patient. His operation involved dissection of the layers of the inguinal canal to the transversalis fascia and then a reconstruction of the floor of the inguinal canal in several layers. The success of the Bassini repair over any of its predecessors ushered in an era of tissue-based repairs. Modifications of the Bassini repair were ...

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