Stoppa method - forgotten surgery.

Stoppa method - forgotten surgery.

Heroic Measures for an American Hero: Attempting to Save the Life of General Douglas MacArthur.

General Douglas MacArthur was a towering public figure on an international stage for the first half of the 20th century. He was healthy throughout his life but developed a series of medical problems when he entered his 80s. This article reviews the General's medical care during two separate life-threatening medical crises that required surgical intervention. The first episode occurred in 1960 when MacArthur presented with renal failure due to an obstructed prostate. Four years later after his 84th birthday, MacArthur developed bile duct obstruction from common duct stones. He underwent an uncomplicated cholecystectomy and common duct exploration but developed variceal bleeding requiring an emergent splenorenal shunt. His terminal event was precipitated by strangulated bowel in long-ignored very large inguinal hernias. MacArthur died, despite state-of-the-art surgical intervention, due to renal failure and hepatic coma.

Made in Italy for hernia: the Italian history of groin hernia repair.

UNLABELLED: The history of groin hernia surgery is as long as the history of surgery. For many centuries doctors, anatomists and surgeons have been devoted to this pathology, afflicting the mankind throughout its evolution. Since ancient times the Italian contribution has been very important with many representative personalities. Authors, investigators and pioneers are really well represented. Every period (the classic period, the Middle Age, the Renaissance and the post-Renaissance) opened new perspectives for a better understanding. During the 18th century, more information about groin anatomy, mainly due to Antonio Scarpa, prepared the Bassini revolution. Edoardo Bassini developed the first modern anatomically based hernia repair. This procedure spread worldwide becoming the most performed surgical technique. After World War II synthetic meshes were introduced and a new era has begun for hernia repair, once again with the support of Italian surgeons, first of all Ermanno Trabucco. But Italian contribution extends also to educational, with the first national school for abdominal wall surgery starting in Rome, and to Italian participation and support in international scientific societies. Authors hereby wish to resume this long history highlighting the "made in Italy" for groin hernia surgery. KEY WORDS: Bassini, Groin hernia, History, Prosthetic repair.

Lloyd Nyhus and Rene Stoppa: preperitoneal inguinal pioneers.

A brief history of the seminal contributions of Stoppa and Nyhus to inguinal hernia surgery.

[Sant'Ippazio (St. Hypatius of Gangra): A southern Italian cult of virility and red carrots]. / Sant'Ippazio (St. Hypatius von Gangra) : Ein süditalienischer Kult um Potenz und Pastinaken.

Sant'Ippazio (St. Hypatius of Gangra) is a saint, martyr, and advocate in cases of impotency, inguinal hernia, and other abdominal disorders. In Tiggiano, a small town at the southernmost point of Italy, Sant'Ippazio, bishop of Gangra, is venerated as a patron saint. According to legend, during an excited dispute on the question of the Arian heresy at the synod of Nicaea (325 AD), Bishop Ippazio was kicked in the lower abdominal region by an Arian presbyter, which caused an inguinal hernia. Therefore, his help is sought for relief and cure of hernia or impotency. Every January 19th, the day of the parish fair, particular carrots (the "pastinache") which have a reddish to violet color are sold. They are said to be similar to the saint's penis after the kick. Also described in this article are other pagan fertility rituals which have been christianized by the veneration of a saint and which are still kept alive among local populations.

Crucial steps in the evolution of the preperitoneal approaches to the groin: an historical review.

Preperitoneal approaches to the repair of primary, bilateral, recurrent, inguinal, and femoral herniae, the most common abdominal protrusions, now dominate techniques of repair. The purpose of this review is to outline crucial steps which have led to this result. Abernethy (Surgical cases and remarks. Of the operation for the aneurysm. Cadell and Davies (Strand), London, pp. 149-176, 1797) introduced an operation to treat aneurysms of the external iliac artery, which was endorsed by Cooper (The anatomy and surgical treatment of abdominal hernia. Longman and Co, London, 1804). Bogros (Essai sur l'anatomie chirurgical de la region iliac et description d'un nouveau procede pour faire la ligature des arteries epigastric et iliaque externe. Th. Paris, no. 153. A Paris, de l'imprimerie de Didot le Jeune, imprimeur de la Faculte de Medicine, rue des Macons, Sorbonne no. 13, 1823) described his preperitoneal space which continues into the suprapubic space of Retzius. Annandale (Edinb Med J 21:1087-1091, 1876) initiated anterior preperitoneal repair. Cheatle (Br Med J 2:68-69, 1920, Br Med J 2:1025-1026, 1921) demonstrated the median posterior preperitoneal approach, resurrected by Henry (Lancet 1:531-533, 1936). McEvedy (Ann R Coll Surg Engl 7:484-496, 1950) modified the Cheatle-Henry procedure by using a unilateral oblique incision in the rectus sheath and underlying transversalis fascia with medial retraction of the rectus muscle. Estrin et al. (Surg Gynecol Obstet 116:547-550, 1963) reinforced this repair with prostheses attached to Cooper's ligament, thereby, eliminating tension. Anterior prosthetic preperitoneal repair was introduced by Usher et al. (Am Surg 24:969-974, 1958) using polyethylene and, later, polypropylene meshes which were not slit, since the spermatic cord was lateralized. Stoppa et al., beginning in 1965, performed giant prosthetic reinforcement of the visceral sac, covering Fruchaud's myopectineal orifice preperitoneally with extensive overlap. They used a posterior approach to avoid scarring in recurrent cases and to allow the exposure of large, bilateral, inguinal, and femoral sacs (Rev Med Picardie 1:46-46, 1972). Wantz (Surg Gynecol Obstet, 169:408-417, 1989) proposed a unilateral version. Gilbert (Am J Surg 163:331-335, 1992) described the anterior preperitoneal sutureless repair of groin herniation. He employed a two-layered prosthesis, the upper resting on the transversalis fascia, the lower in the space of Bogros. They were connected by a plug passed through the internal inguinal ring. Kugel (Am J Surg 178:298-302, 1999) described his anterior preperitoneal prosthetic repair of groin herniation through an abdominal gridiron incision. Laparoscopic repair of groin protrusions began in 1982 (Ger; Ann R Coll Surg Engl 64:342-344, 1982). In 1992, Arregui et al. (Surg Laparosc Endosc 2:53-58, 1992) and Dion and Morin (Can J Surg 35:209-212, 1992) reported on their transabdominal preperitoneal (TAPP) approach. To avoid intraperitoneal complications, Dulucq (Cahiers Chir 79:15-16, 1991) recommended a totally extraperitoneal (TEP) approach. These techniques incur fewer recurrences than open techniques and diminish postoperative pain. However, the operating time is longer, they are more expensive, and special skills are needed. In addition, general anesthesia is required. Thus, late in the 18th century, surgeons began incising the groin to treat aneurysms there. This experience led to the discovery of the preperitoneal space of Bogros, which, in the 1870 s, was employed for the anterior repair of groin herniation. The posterior preperitoneal approach became established in the 1920s-1960s, along with the use of prostheses. Laparoscopy was applied near the end of the century.

Inguinal hernia: the quest for the best repair.

BACKGROUND: Inguinal hernia repair may be the most common procedure in general surgery. Many repairs have been described but none appears completely satisfactory. A brief look at the popular methods of repair from the traditional tissue approximation to the current mesh-based techniques is presented. METHODS: The PubMed database was searched for all English language literature. Further references were obtained through cross-referencing the bibliography cited in each work and using books from the authors' collection. CONCLUSION: The history of inguinal hernia is a rich one, from the traditional tissue approximation techniques to the current mesh-based repairs which are now performed as open or laparoscopic procedures. Recurrent rates have reduced but are still a problem. Perhaps the perfect repair remains elusive because the problem may also be with patients' collagen not just the surgical procedure.

Herniology: past, present, and future.

INTRODUCTION: Despite herniorrhaphy being performed frequently, most surgeons consider it to be a minor procedure. However, a few surgeons' views differed. THE PAST: The Master was Bassini (1884), who introduced a radical cure for inguinal hernia. Incising his triple layer, internal oblique, transversus, and transversalis, he entered the preperitoneal space, allowing high ligation of the sac and mass suturing to the inguinal ligament. A 2.7% recurrence rate evoked worldwide emulation. Corruption ensued. The cremaster remained and few unincised layers were stitched, without imbrications, along with reinforcement using the cremaster or rectus muscles, fascial flaps, relaxing incisions, and silver coils. Little improvement cast doubt on Bassini's work. Russell's (Lancet 2:1197-1203, 1906) ligation of the hernial sac was adopted until 1953, when the Shouldice clinic revived Bassini's tenets, becoming the gold standard for decades. Cheatle (Br Med J 2:68-69, 1920) introduced posterior pre-peritoneal repair. Acquaviva and Bourret (Presse Med 73:892, 1948) designed the first plastic prosthesis (nylon), replaced by polypropylene. Usher (Surg Gynecol Obstet 117:239-240, 1963) parietalized the cord. These contributions paved the way for the Rives, Stoppa, Wantz, and Gilbert repairs, Ger's laparoscopic approach, and less common herniorrhaphies. THE PRESENT: Chevrel (1979) formed the GREPA, which evolved into the European Hernia Society (EHS), joining with the American Hernia Society (AHS) to form the journal 'Hernia.' Nilsson (1993) instituted national hernia registries, enabling less recurrences and better prospective research. THE FUTURE: In the 21st century, the Lichtenstein procedure has dominated inguinal herniorrhaphy. Herniologists accepted systemic connective tissue disorder as the etiology of abdominal hernia and pelvic prolapses. This malady explains why prostheses slow but do not eliminate recurrence. Antidotes need to be developed and employed. CONCLUSION: This malady explains why prostheses slow but do not eliminate recurrence. Antidotes need to be developed and employed.

Demetrius Cantemir: the first account of transabodominal approach to repair groin hernia.

The first description of the transabdominal approach for hernia repair was written by Demetrius Cantemir, Prince of Moldavia and encyclopedic scholar, in his 1716 Latin manuscript "Incrementa et decrementa Aulae Othomaniae" ("The history of the Growth and Decay of the Ottoman Empire"). This manuscript was one of the most important in Eastern Europe at the time. It was first translated in English in 1734 by N. Tyndal, and all subsequent translations into various other languages were based on this english version. The original manuscript now belongs to the Houghton Library of Harvard University, where it was recently discovered in 1984 by V. Candea. Our article presents for the first time the complete account of the surgical procedure performed by Albanian physicians in the prince's palace in Constantinopol. The patient was the Prince's secretary. There is a detailed description of the operation, postoperative therapy and the medical course to recovery. The text presented is translated in English from Annotations of Volume Two, chapter four. We consider it worthwhile to present to the medical community this valuable but less known contribution to the history of medicine.

An early observation on the anatomy of the inguinal canal and the etiology of inguinal hernias by Petrus Camper in the 18th century.

The famous Dutch medical doctor Petrus Camper (1722-1789) was appointed professor of anatomy and surgery at the University of Franeker, Amsterdam, and Groningen. As Praelector Anatomiae of the Amsterdam Guild of Surgeons, he gave public anatomy lessons in the Anatomy theatre in Amsterdam. During the mid 18th century he performed dissections on corpses of children and adults to investigate the anatomy and etiology of inguinal hernias. The concept that a hernia was caused by "a rupture of the peritoneum" was common at that time. Camper concluded that this was incorrect and provided a clear description of the etiology of hernias in children and adults. For the treatment of inguinal hernias, he designed a truss based on the geometrical proportions of the pelvis. This "truss of Camper" was much used and internationally renowned. His anatomical studies and perfect, self-drawn illustrations contributed to a better understanding of the anatomy of the inguinal canal, on the national as well as international level. Camper's "Icones Herniarum" is his most widely known work on inguinal hernias and included a series of outstanding anatomical illustrations. Petrus Camper should be considered one of the pioneers in the field of inguinal hernias.

[Demetrius Cantemir in the history of surgery: the first account of transabdominal approach to repair groin hernias]. / Dimitrie cantemir în istoria universala a chirurgiei: prima descriere a caii transabdominale în cura herniilor.

The first description of the transabdominal approach for hernia repair was written by Demetrius Cantemir, Prince of Moldavia and encyclopedic scholar, in his 1716 Latin manuscript "Incrementa et Decrementa Aulae Othmanicae". This manuscript was one of the most important of Eastern Europe at the time. It was first translated in English in 1734, and all subsequent translations into various other languages were based on this English version. The original manuscript now belongs to the Houghton Library of Harvard University, where it was recently rediscovered in 1984 by V. Candea. D. Slusanschi has made the first Romanian translation of the first two volumes based on the original latin manuscript. This translation is now in press. Our article presents for the first time a fragment of this Romanian translation from the Annotations of Volume two, chapter four. In this fragment, Demetrius Cantemir describes the surgical procedure practiced by Albanian physicians in the prince's palace in Constantinopol. The patient was the secretary of the prince. There is a detailed description of the postsurgical therapy and the medical course to recovery. It was first partially reproduced by Mercy in his book on hernia published in 1892, and more recently by Meade in 1965. We consider useful to present to the medical community this valuable but less known contribution to the history of medicine.

[The history of treatment of groin hernia]. / Rys historyczny leczenia chirurgicznego przepuklin.

Hernia (Greek kele/hernios--bud or offshoot) was present in the human history from its very beginning. The role of surgery was restricted to the treatment of huge umbilical and groin hernias and life-threatening incarcerated hernias. The treatment of groin hernia can be divided into five eras. The oldest epoch was ancient era from ancient Egypt to 15th century. The Egyptian Papirus of Ebers contains description of a hernia: swelling that comes out during coughing. Most essential knowledge concerning hernias in ancient times derives from Galen. This knowledge with minor modifications was valid during Middle Ages and eventually in the Renaissance the second era of hernia treatment began. Herniology flourished mainly due to many anatomical discoveries. In spite of many important discoveries from 18th to 19th century the treatment results were still unsatisfactory. Astley Cooper stated that no disease treated surgically involves from surgeon so broad knowledge and skills as hernia and its many variants. Introduction of anesthesia and antiseptic procedures constituted the beginning of modern hernia surgery known as era of hernia repair under tension (19th to middle 20th century). Three substantial rules were introduced to hernia repair technique: antiseptic and aseptic procedures. high ligation of hernia sac and narrowing of the internal inguinal ring. In spite of the progress the treatment results were poor. Recurrence rate during four years was ca. 100% and postoperative mortality gained even 7%. The treatment results were satisfactory after new surgical technique described by Bassini was implemented. Bassini introduced the next rule of hernia repair ie. reconstruction of the posterior wall of inguinal canal. The next landmark in inguinal hernia surgery was the method described by Canadian surgeon E. Shouldice. He proposed imbrication of the transverse fascia and strengthening of the posterior wall of inguinal canal by four layers of fasciae and aponeuroses of oblique muscles. These modifications decreased recurrence rate to 3%. The next epoch in the history of hernia surgery lasting to present days is referred to as era of tensionless hernia repair. The tension of sutured layers was reduced by incisions of the rectal abdominal muscle sheath or using of foreign materials. The turning point in hernia surgery was discovery of synthetic polymers by Carothers in 1935. The first tensionless technique described by Lichtenstein was based on strengthening of the posterior wall of inguinal canal with prosthetic material. Lichtenstein published the data on 1,000 operations with Marlex mesh without any recurrence in 5 years after surgery. Thus fifth rule of groin hernia repair was introduced--tensionless repair. Another treatment method was popularized by Rene Stoppa, who used Dacron mesh situated in preperitoneal space without fixing sutures. First such operation was performed in 1975, and reported recurrence rates were quite low (1.4%). The next type of repair procedure was sticking of a synthetic plug into inguinal canal. Lichtenstein in 1968 used Marlex mesh plug (in shape of a cigarette) in the treatment of inguinal and femoral hernias. The mesh was fixated with single sutures. The next step was introduction of a Prolene Hernia System which enabled repair of the tissue defect in three spaces: preperitoneal, above transverse fascia and inside inguinal canal. Laproscopic treatment of groin hernias began in 20th century. The first laparoscopic procedure was performed by P. Fletcher in 1979. In 1990 Schultz plugged inguinal canal with polypropylene mesh. Later such methods like TAPP and TEP were introduced. The disadvantages of laparoscopic approach were: high cost and risk connected with general anesthesia. In conclusion it may be stated that history of groin hernia repair evolved from life-saving procedures in case of incarcerated hernias to elective operations performed within the limits of 1 day surgery.

Privates on parade: soldiers, medicine and the treatment of inguinal hernias in Georgian England.

Hernias were prevalent among servicemen, typically recruited from amongst the malnourished. Civilian medical practice deemed the rupture incurable, taking a palliative approach. For the military this was unacceptable: wastage rates due to ruptures were high, servicemen were valuable commodities. Examples here are used to illustrate that experimentation was a contentious activity, reliant on the whims of patronage and war-time budgets. Although military hospitals provided a good venue to engage in experimentation it was contested.