History of inguinal hernia repair, laparoendoscopic techniques, implementation in surgical praxis, and future perspectives: Considerations of two pioneers

Those who do not know the past cannot understand the present and cannot shape the future. (Helmut Kohl, Chancellor of Germany 1982–1998). INTRODUCTION: Historical development of open and laparoendoscopic inguinal hernia repair is presented. Advantages and disadvantages of currently used techniques as well as problems related to the implementation of the minimal invasive techniques in daily surgical work are discussed. MATERIALS AND METHODS: Intensive study of the literature and our own personal experience with the performance of transabdominal preperitoneal patch plasty (TAPP) and totally extraperitoneal patch plasty (TEP) were used. Systematic descriptions of the TAPP and TEP techniques to achieve the best results are summarized. The penetration rate of the laparoendoscopic techniques worldwide is reviewed. RESULTS: Laparoendoscopic inguinal hernia repair is superior to open surgery with respect to all pain-associated parameters. Profound knowledge of the anatomy of the groin, of the pathophysiology of hernia development as well as of the working mechanisms of the surgical techniques are described as being the key features for successful treatment. The worldwide penetration rate of TAPP/TEP is dependent on the respective country and varies between 1% and 80%. The main reasons for these striking differences are the preference of individual surgeons, available resources of the specific national health care systems, differences in training facilities, and even differences in insurance coverage. New imaging systems as well as robot-assisted techniques are still need to be evaluated sufficiently for final recommendations. CONCLUSION: TAPP and TEP are well-established techniques of minimally invasive repair of inguinal hernias. Both techniques are safe, reliable, and cost-effective. Despite some meaningful advantages in comparison to open surgery, the penetration rate in most of the countries, however, remains low. Improvement of training techniques and facilities is urgently needed. Robot-assisted techniques and the use of simulators may be the promoter of laparoscopic inguinal hernia repair in the future.