Evolution of Laparoscopic Hernia Repair
The concept of a posterior approach to the repair of abdominal wall hernias had its earliest beginnings in North America in 1878 in Utica, New York, when E. Hutchinson reported a case of inguinal hernia that was strangulated at the internal ring. Hutchins
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Evolution of Laparoscopic Hernia Repair Karl LeBlanc and Ralph Ger
The concept of a posterior approach to the repair of abdominal wall hernias had its earliest beginnings in North America in 1878 in Utica, New York, when E. Hutchinson reported a case of inguinal hernia that was strangulated at the internal ring. Hutchinson made a midline incision between the umbilicus and the pubis. Entering the peritoneal cavity, he released the gangrenous bowel, but the patient died the following day.1 Annandale was the first (1876) to enter the preperitoneal space through an incision parallel to Poupart's ligament for the purpose of treating an indirect and femoral hernia. 2 But it was 50 years earlier still, in 1823, that the first surgeon entered the preperitoneal space: searching for a safer approach to the ligation of the external iliac artery, A. J. Bogros investigated and described the space now known by his name. s Tait (1891), Cheatle (1920), Henry (1936) and McEvedy (1966) described this "newer" approach to hernia repair through the preperitoneal space. 4 This approach was rediscovered and established by Nyhus (1959) as an effective method of herniorraphy.5 The benefits of using a prosthetic mesh placed in the preperitoneal space were shown by Rignault,6 NyhUS,' Stoppa,8 and Wantz. 9 These surgeons did not have access to laparoscopic methodology at that time to investigate this method of access to the abdominal or preperitoneal spaces.
First Use The first report of the use of the laparoscope in the repair of an abdominal hernia was made by Ger in 1982. 10 He reported a series of 13 patients treated in the 1970s in which he closed the peritoneal opening of the sac using Michel clips. All but the last patient in this series was repaired through an open incision. The thirteenth patient was repaired in 1979 under laparoscopic guidance with a special stapling device. The first report of the use of the laparoscope in the repair of abdominal hernias was made by Ger in 1982. 10 He reported a series of 12 patients treated in the 1970s in which he closed the peritoneal opening of the sac through an open abdominal incision using Michel clips. In a thirteenth patient the repair was carried out in 1979 under laparoscopic guidance with a special stapling device. The patient was lost to follow up after a short period. Ger continued his efforts to repair these hernias laparoscopically. He reported the closure of the neck of
R. Bendavid et al. (eds.), Abdominal Wall Hernias © Springer Science+Business Media New York 2001
the hernia sac using a prototype instrument called the "herniostat" in beagle dogs.!1 The results in these models seemed promising. In that same article, he reported the potential benefits of the laparoscopic approach to groin hernia repair as: (1) creation of puncture wounds rather than formal incisions; (2) minimal dissection; (3) less risk of spermatic cord injury and ischemic orchitis; (4) minimal risk of bladder injury; (5) decreased incidence of neuralgias; (6) possibility of an outpatient procedure; (7) abili
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