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18Wojciech Szczęsny et al.hernias. Hernia belts were in use in Rome; in case ofincarceration the spermatic cord and testis were removedvia an incision in the scrotum and the woundleft to heal by granulation. Incarceration was not theonly indication for surgery in ancient times - herniotomywas also performed for persistent pain. Paul ofAegina operated scrotal hernias by ligating both thehernial sac and the spermatic cord – sacrificing thetestis. Celsus attempted to spare the testis while operating[2].During the Middle Ages there has been little advancein hernia surgery, even though some of the mostrenowned physicians of that era took an interest in thatarea. William of Saliceto followed the path Celsus hadtaken thirteen centuries before him, striving to sparethe testis while performing surgery for inguinal hernia.Guy de Chauliac was able to discern between femoraland inguinal hernias and used the Trendelenburg positionduring hernia reduction.The wonderful advancement of science during theRenaissance era concerned medicine as well. AntonioBenivieni (1440-1502), one of the founding fathers ofpathology, wrote extensively about various hernias inhis “De abditis morborum causis („On the hiddencauses of diseases”). The greatest Renaissance surgeon,Ambrose Pare, gave a detailed description ofhernia repair techniques, including drawings. In hispractice he used golden wire as a suturing material. Histechnique included ligation of the hernial sac, its reductioninto the peritoneal cavity and closure of the parietalperitoneum in certain cases. Pare warned againsttraveling herniotomists and barbers, who almost universallycastrated their patients during hernioplasty.This practice was far from marginal, as shown by theexample of Jacques Beaulieu, a XVII th century travelinglithotomist, who performed over 2000 herniotomiesand approximately 4500 cystolithotomies [2, 3]. In1556 Pierre Franco, a Swiss surgeon, introduced adissector of his own invention to expand the inguinalring in incarcerated hernia. He recommended a reductionof the sac contents and closure with linen sutures[2].Autopsies, performed since the Renaissance, haveled to a vast improvement in the knowledge of humananatomy. In 1559 Kaspar Stromayr first distinguishedbetween direct and indirect hernia. Advances in otherareas of science have led to an accumulation of knowledgeon human anatomy, physiology and pathology.During the following decades, both theoretical researchand attempts at new operative techniques continued. In1721 Chesleden successfully operated an incarceratedscrotal hernia, while Percival Pott published a report onthe pathogenesis of incarceration in 1757 [2,4].The XVIII th century was a period of intense investigationsof inguinal anatomy. Many names of theresearchers of that era, such as Cooper, Skarpa, Gimbernathave entered the language of anatomy forever.Gimbernat advised dissection of the inguinal ring laterallyrather than cephalad in cases of strangulated hernia,which led to life-threatening hemorrhages anddamage to the inguinal ligament. Despite the significantadvances in theoretical knowledge, the outcomesof surgical treatment did not improve markedly, partiallydue to the lack of the rules of aseptic and antisepticsurgery. The introduction of the latter coincidedwith the advent of a new era of herniology heralded byBassini. Earlier, in 1871, Marcy, who was a student ofLister, performed the first antiseptic hernioplasty. In1874 Steele reported a „radical hernia operation”which consisted of hernia reduction and closure of thesuperficial inguinal ring. Lucas-Championniere wasthe first to open the inguinal canal in 1881 (through anincision in the external oblique aponeurosis) and excisethe hernial sac to the level of the deep inguinal ring.Five years later, Mac Ewen folded the peritoneum ofthe sac and placed it as a „plug” inside the deep inguinalring, which was additionally reinforced by sutures[2, 5, 6].Despite the use of general anesthesia, aseptic andhigh sac ligation, the outcomes of inguinal hernia surgeryin the latter half of the XIX th surgery were unfavorableboth in Europe and the USA. Mortality ratesdue to sepsis, hemorrhage and other causes reached 2-7% of the cases and the recurrence rate was practically100% after 4 years. As Billroth stated in 1890, mostsurgeons at that time left the wound to heal by secondaryintention after sac ligation, believing that theresulting scar would reinforce the abdominal wall,preventing recurrence. By the end of the XIX th centuryroutine resection and primary anastomosis were introducedin cases of gut necrosis due to strangulation [7].BREAKTHROUGHPrior to his famous operation, Eduardo Bassiniused numerous techniques to treat inguinal hernias.Through analyzing his failures, he came to understandthe principle of correct inguinal hernia repair: insteadof closing the deep inguinal ring, one should strive torecreate physiological anatomical relationships be-