Treatment of Inguinal Hernias - Important Place of Cœliosurgery

Up until the end of the XIX° century, strangulated inguinal hernia was mortal. In spite of Celse, Heliodore, Chauliac, Ambroise Paré, even inguinal surgery was perilous, emasculating and often fatal. It is the era of taxis and truss. The modern era, with anaesthesia, asepsis, begins in Padoue when Edoardo Bassini (1884) settles the technic of treatment by suture.The Bassini procedure dominates the XX° century with many improvements, (Haalstedt, Mac vay, Fruchaud and so on), until the Ryan technic at the Shouldice Hospital. At the end of the XX° and the beginning of the XX1° century 2 new facts: generalisation of treatment with prosthesis and cœlioscopic approach. In the nineties, after Mouret and the french cœlioscopic revolution, the Cœliohernioplasty condemned in U.S. begins slowly in France with J.Leroy and G. Fromont with the TAPP procedure and then G.Begin and JL Duluq for the TEP, but the most frequent procedure remains the « open », with strengthening by prosthesis as the « Lichtenstein », which dethrones the Shouldice. In spite of only 2% of recurrence, 2 to 20% chronic pain, 10% of disejaculation and oligospermia slowly tarnish its golden star: the superiority of the posterior cœlioscopic approach appears progressively compared to the anterior conventional one; the open technics go across the sensitive inguinal plexus, great and small abdomino-genital and genito crural nerves, prime cause of pain. More serious, the « shrinkage » or cicatricial retractile sclerosis with prosthesis in contact with the nerves increases the risk of chronic pain. So with a rate of recurrence of 0,3 to O,7% and of chronic pain only 0,12 to O,05%, a return to work in 1 to 14 days versus 23 for the Lichtenstein, the Cœliohernioplasty show clearly the superiority of the posterior approach. Important and interesting too is the rate of genital incidence, testicular atrophy, dysejaculation, oligospermia, practically null in the laparoscopic approach. On the other hand, Cœliohernioplasty TAPP and TEP have a learning curve which requires a longer apprenticeship than the conventional technic.