22Wojciech Szczęsny et al.Those in favor of laparoscopy stress swift rehabilitation<strong>and</strong> diminished pain after these procedures (importante.g. in sportsmen). However, the procedurecarries a risk of typical laparoscopy complications(including fatal ones) <strong>and</strong> requires general anesthesia.The problem is subject to discussion [27 ].Laparoscopic techniques are also used in postoperative<strong>and</strong> parastomal hernia repair. The large size ofimplants required ( the defect is covered with a 5cmmargin) render these procedures rather costly. Previouslaparotomies are other factors limiting the applicationof laparoscopic techniques.BASIC RESEARCHBasic research has played a crucial role in the developmentof herniology. Its origin lies in the uncoveringof human anatomy. Galen connected hernia withperitoneal rupture. Until Renaissance, the awareness ofhuman anatomy in general <strong>and</strong> the relationships withinthe inguinal canal was low. The greatest advances inunderst<strong>and</strong>ing the anatomical foundations of herniaformation took place in the XVIII th <strong>and</strong> XIX th centuries.Even though the anatomical <strong>and</strong> physiologicalrelations within the inguinal region were fully understood,the reason for hernia formation remained unclear.In the early 1900’s, Harrison focused on theconnective tissue of the fascia <strong>and</strong> its abnormalities asa possible causative factor. He observed the incidenceof hernia to grow with age. It was only in the latter halfof the XXth century that Harrison’s suspicions wereconfirmed. Immunohistochemical, histological <strong>and</strong>genetic research has shown significant differences inthe ultrastructure of the fascia forming hernial defectsin comparison to healthy subjects. Moreover, thesealterations were soon found to encompass even tissueslying beyond the actual hernia <strong>and</strong> be gene-related. Thealterations include disrupted synthesis <strong>and</strong> maturationof collagen <strong>and</strong> elastic fibers, as well as increasedexpression of enzymes degrading these structures [29,30, 31].It has to be stressed, however, that not every aspectof the pathogenesis of hernia has been fully explained,<strong>and</strong> the research continues. According to contemporarytheories, hernias have a complex etiology, definitelyincluding congenital factors, concerning connectivetissue structure <strong>and</strong> metabolism.THE FUTUREThe future of herniology is to be sought in improvedsynthetic materials (composite, partially absorbable),as well as perfected surgical techniques.Even today it is no longer the recurrence rate, but othercomplications, such as chronic pain, hematomas, seromasor postoperative testicular edema that are themeasure of correct treatment. Recurrence rates havebeen reduced to approximately 1-1,5% <strong>and</strong>, afterelimination of surgical errors, are attributed to connectivetissue abnormalities. A return to certain types ofall-tissue repair or the continued use of the techniquespresently utilized cannot be excluded. There are stillmany surgeons who distrust synthetic materials, withthe economic aspect being significant in certain regions.An important problem appears to be the possibilityto assess the quality of the connective tissue prior tosurgery. An outcome of such a test would influence thechoice of the repair technique. If connective tissueabnormalities would be found, a synthetic materialwould be used, <strong>and</strong> if the tissue would be assessed ashealthy, all-tissue repair would be justified.REFERENNCES1. Zieliński W. : Słownik pochodzenia nazw i określeńmedycznych. Α – medica press 2004; Bielsko Biała.2. Lau W. : History of treatment of groin hernia. World JSurg 2002; 26: 748-759.3. Johnson J, Scottt R, Hazey J et al.. : The history of openinguinal hernia repair. Current Surgery 2004; 61: 49-52.4. Stoppa R, Wantz G, Munegato G i wsp. : Hernia healers.Arnette 1998.5. Steele C. On operations for radical cure of hernia. BMJ1874;2;584.6. MacEwen W. On the radical cure of oblique inguinalhernia by internal abdominal peritoneal pad, <strong>and</strong> the restorationof the valved form of the inguinal canal. AnnSurg 1886;4;89–119.7. Read RC. The development of inguinal herniorrhaphy.Surg Clin North Am 1984;64;185–196.8. Bassini E. Sulla cura radicule dellérnia inguinale. Arch.Soc Ital Chir 1887;4;380.9. Halsted WS. The radical cure of hernia. Johns HopkinsHosp Bull 1889;1;12–13.10. McVay CB, Anson BJ. Composition of the rectus sheath.Anat. Rec. 1940;77;213–225.11. Marcy HO. The cure of hernia. J.A.M.A. 1887;8;589–592.12. McArthur LL. Autoplastic suture in hernia <strong>and</strong> otherdiastases.J.A.M.A. 1901;37;1162–1165.13. Desarda MP. New method of inguinal hernia repair: A
The history <strong>and</strong> the present of herniology 23new solution. ANZ J Surg 2001;71:241-4.14. Loewe O.: Über Hautimplantation der freien Faszienplastik.Münch Med Wochenschr 1913; 60: 1320-1323.15. Jankowski T.: Zamknięcie wielkich wrót przepuklinowychza pomocą pogrążonego płata skórnego. Pol PrzegChir 1953; 25: 499-503.16. Hoffmana A.: Wyniki leczenie dużych przepuklinbrzusznych zmodyfikowanym sposobem Leziusa. Pam.45 Zjazdu Chir Pol 1970, 792-793.17. Prywiński S.: Otyłość jako czynnik ryzyka w leczeniudużych przepuklin pooperacyjnych techniką pogrążonegopłata skóry własnej. Praca doktorska. AM Bydgoszcz1995.18. Schumpelick V, Klinge U. Prosthetic implants for herniarepair. Br J Surg 2003; 90: 1457-145819. Read R. The contributions of Usher <strong>and</strong> others to theelimination of tension from groin herniorrhaphy. Hernia2005; 9: 208-211.20. Usher FC, Gannon JP. Marlex mesh: a new plastic meshfor replacing tissue defects. I. Experimental studies.Arch. Surg. 1959;78:131– 137.21. Lichtenstein IL, Schulman AG, Amid PK. et al: Thetension-free hernioplasty. Am. J. Surg. 1989;157;188–193.22. Benedettti M, Albertario S, Niebel T. et al..: Intestinalperforation as a long-term complication of plug <strong>and</strong> meshinguinal hernioplasty: case report. Hernia 2005; 9: 93-95.23. G. Welty, U. Klinge, B. Klosterhalfen, R. et al.: Functionalimpairment <strong>and</strong> complaints following incisionalhernia repair with different polypropylene meshes. Hernia2001; 5: 142-147.24. Stoppa RE, Petit J, Henry X. Unsutured Dacron prosthesisin groin hernias. Int. Surg. 1975;60;411–415.25. Nyhus LM, Pollak R, Bombeck CT. et al. The preperitonealapproach <strong>and</strong> prosthetic buttress repair for recurrenthernia: the evolution of a technique. Ann. Surg.1988;208;733–737.26. Shouldice EE. The treatment of hernia. Ontario Med.Rev. 1953;1; 1–14.27. Novitsky Y, Czerniach D, Kercher K. et al.: , Advantagesof laparoscopic transabdominal preperitoneal herniorrhaphyin the evaluation <strong>and</strong> management of inguinalhernias Am J Surg 2007; 193: 466–470.28. Wagh P, Read R: Defective collagen synthesis in inguinalherniation. Am J Surg 1972; 124:819-822.29. Si Z, Rhanjit B, Rosch R. et al. : Impaired balance oftype I <strong>and</strong> type III procollagen mRNA in cultured fibroblastsof patients with incisional hernia. Surgery 2002;131, 324-31.30. Klinge U, Zheng H, Si Z. et al. : Expression of the extracellularmatrix proteins collagen I, collagen III <strong>and</strong> fibronectin<strong>and</strong> matrix metalloproteinease-1 <strong>and</strong> –13 in theskin of patients with inguinal hernia. Eur Surg Res 1999,31:480-490.Address for correspondence:Wojciech SzczęsnyKatedra i Klinika Chirurgii Ogólneji EndokrynologicznejUMK w Toruniu<strong>Collegium</strong> <strong>Medicum</strong> im. Ludwika Rydygieraul. M. Skłodowskiej-Curie 985-094 Bydgoszcztel./fax: +48 52 585 40 16e-mail: wojszcz@interia.plReceived: 27.05.2008Accepted for publication: 17.06.2008
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