Hernia repair in the year 2000:: A survey

Introduction: More than 100 years after Bassini, the technical approach to hernia is still a subject of debate, despite the magnitude of hernia repairs performed worldwide each year. We evaluated the outcome of the most common technical approaches in order to specify adequate treatment options. Techniques: Besides the herniorrhaphy procedure (Shouldice, Bassini, Lotheisen and McVay), hernioplasty (Lichtenstein) has gained popularity over the last few years. This technique is also performed laparoscopically - either trans- or extraperitoneally. Results: The Shouldice procedure is superior to the Bassini method, especially for recurrent hernias. The success of hernioplasty (Lichtenstein) shows almost no recurrencies. Similar results are demonstrated by the laparoscopic procedure. However, these latter results are still influenced by the teaming curve. Only open surgical management allows intraoperative decision on the most suitable procedure (-raphy or -plasty), thus avoiding overtreatment of low-degree Nyhus hernias. At the least, laparoscopy should be the chosen procedure for recurrent or bilateral hernia management. The good socio-economical aspects of laparoscopically managed hernia repair is an advantage. Conclusion: Depending on the Nyhus classification, the "tension-free" technique is preferred in open surgery and laparoscopically, the extraperitoneoscopic approach is advisable.