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The history and the present of herniology 19tween the elements of the inguinal canal and to reinforceits posterior wall. His original technique (whichhas, over time, spawned numerous modifications) was,similarly to the later introduced Shouldice repair,based on a longitudinal incision of the transverse fasciaranging from the pubic tubercle to approximately 2.5cm above the deep ring. Thus, he gained wide access tothe preperitoneal space, which allowed for high ligationof the hernial sac. The medial non-absorbable silksutures ran through the rectus sheath. Bassini was thefirst to closely follow up his patients. In 1887, threeyears after his initial operation, he presented the outcomesof his treatment at the congress of Italian surgeonsin Genoa. A beautifully illustrated monograph,published in 1889 and translated into German in 1890,spawned a tremendous interest in the new method.Soon, Bassini’s position as the founding father of modernherniology was unchallengeable [8].At roughly the same time, William Halsted presentedhis method of inguinal hernia repair. The maindifference from Bassini’s technique was the placementof the spermatic cord (often with the cremaster muscleand pampiniform plexus resected) above the closedexternal oblique anastomosis. Both these great surgeonshave set the fourth principle of successful inguinalhernia repair. They have added reinforcement ofthe posterior wall of the inguinal canal to the threeprinciples already known: aseptic/antiseptic surgery,high sac ligation and reduced diameter of the deepinguinal ring. they have also stressed the importance ofthe transverse fascia [8, 9 ].The basic drawback to Bassini’s repair was the tensionarising along the suture line, causing pain andrecurrence. To reduce the tension, in 1892 Wolferperformed an incision of the anterior layer of the rectussheath. Berger made a similar incision, but he fastenedthe lateral flap of the incised rectus sheath to Poupart’sligament. The idea was approved by Halsted, whodiscarded his previous principle of spermatic cordthinning, developing a new type of hernia repair (theHalsted II technique). This type of inguinal herniarepair was further studied and developed by McVayand Anson, who have confirmed its usefulness on alarge group of patients [10 ].The use of foreign materials was the next logicalstage in inguinal hernia repair. This solution was pioneeredby Marcy, who implanted kangaroo tendons tocover a tissue defect as early as 1887. He also experimentedwith fasciae of other animals. In 1901McArthur initiated the era of fascial repair, using avascularized flap of the external oblique aponeurosis.This concept was revisited 80 years later in India byMohan Desarda [11, 12, 13 ]. The external obliqueaponeurosis was soon considered insufficient, whichled to the use of the fascia lata as a free or pedicle flap.This method was popularized in England by GeoffreyKeynes, who used it in femoral hernias as well (suturingthe flap to Cooper’s ligament). In later years, reportson various biological materials had been publishedup to 1975, when Sames proposed the use of thevas deferens as suturing material [2, 3].The use of human skin for inguinal hernia repairforms a separate chapter. This material, being autogenous,has been considered infection-resistant. Loewewas one of the pioneers of its use, implanting humanskin in seven patients, including one with a postoperativehernia, in 1913 [14]. The procedure was popularizedby Rehn, who prepared the skin by scraping offthe epidermis to prevent fistula and cyst formation. InPoland human skin was introduced to herniology byJankowski [15 ]. One of the ways to prepare the skinflap was exposure to high temperature and epidermisremoval, described by Hoffman in 1970 [16 ]. Thismethod was in use in our Clinic, but long-term outcomeshave proven far from perfect. The introductionof synthetic materials has practically eliminated humanskin as prosthetic material [ 17 ].The ancient concept of metal as an implant wasalso revisited. The materials used included silver -„silver mesh filigree”(Witzel and Goepel), tantalum(Burke) , steel (Babcock) and gold. The initial enthusiasmwaned when complications in the form of cysts,tissue damage and high recurrence rates became apparent.These materials remained in use until the early1960’s [2].By the end of the XIX th century, the luminaries inthe field of surgery gained certainty that the road tosuccessful hernia repair led through the use of syntheticmaterials. In a 1878 letter Billroth wrote toCzerny: „If we learn to manufacture artificial tissueswith the properties of fasciae and tendons, we willsolve the problem of radical hernia repair” [4].In 1935 nylon was synthesized. Its biocompatibilitywas soon appreciated and it was introduced to surgery,including herniology. Melick developed the„nylon darn” technique, which remains in use today.Based on the considerations on nylon, the problemof the ideal hernia prosthesis arose. The desired materialshould meet the criteria set by Schumpelick [18 ]:– properties must not be altered by exposure to bodily