Hernia repair is one of the most common major operations performed in the United States. Every year, over one half million Americans undergo surgery for the treatment of this problem.

A hernia is a common ailment presently corrected by surgery in an outpatient surgery center or hospital. It can be congenital or traumatic origin. If not corrected, the hernia can incarcerate, followed by strangulation, which is a life threatening condition.

The most common of all hernias, the inguinal, occurs in the groin area. Protrusions elsewhere on the abdominal wall are called femoral and umbilical hernias. Highest up of all is the hiatal hernia, which occurs when part of the stomach pushes through the diaphragm separating the chest and the abdomen.

In the last decade of the nineteenth century, rapid advances in the knowledge of anatomy, surgical antisepsis, and anesthesia led to surgical treatment of hernias. Different methods of "layer closure" were devised during this period by surgeons in Italy, France and the United States.

The classic procedures developed by these surgeons formed the foundation of modern herniorrhaphy and they have been applied, essentially without significant alteration or improvement, for the past 100 years. However, even with this modification at the present time, the surgery carries a recurrence rate between 10% and 12%.

In 1940, Canadian surgeon Dr. E.E. Shouldice devised a new technique for hernia repair. The emphasis in the repair was based on the utilization of the transversalis fascia in an overlapping fashion. This method dramatically reduced the recurrence rate to 1.5% to 2%.

During the 1970's, Dr. Usher pioneered the use of polypropylene mesh in repair of abdominal wall hernias. Various methods of repair for all types of hernias began using this mesh.

In 1989, Dr. Robert M. Moran of our Institute combined the Shouldice technique with a preperitoneal insertion of a specialized polypropylene mesh manufactured by Ethicon© in repairing abdominal wall hernias. This concept has become the repair adopted by all surgeons at the National Ambulatory Hernia Institute with a resultant decrease of recurrence of these hernias to 0.4%.

In the last decade of the nineteenth century, there was a rapid advance in the knowledge of anatomy, surgical antisepsis, and anesthesia which led to the surgical treatment of the hernia.
During this time period, Dr. E Bassini in Italy, Dr. W.S. Halsted and Dr. A.H. Ferguson in the United States, and Dr. G. Lotheissen in France devised different varieties of layered closure for the defects remaining after sac ligation. These classic procedures form the foundation of modern herniorrhaphy and they have been applied essentially without significant alteration or improvement for over 100 years.

Today, most repairs of inguinal hernias are still based on these century-old techniques with recurrence rates of 10 to 12%. However, in 1940, Dr. E.E. Shouldice developed the multi-layer closure based on the transversalis fascia with recurrence rates of 1-1/2 to 2%.

In 1959, Dr. F.C. Usher introduced the use of polypropylene mesh in the repair of primary and recurrent hernias. This was followed by various mesh techniques.

Twenty-five years ago, the original description of the Shouldice hernia repair was published by Dr. Moran in a national surgical journal, Surgery. It was recognized as an important contribution by the Yearbook of Surgery. In 1988, the surgeons of the Hernia Institute combined these two procedures for our current repair. The principles of our repair are local anesthesia, a standard Shouldice dissection, and insertion of the Ethicon© polypropylene mesh beneath the transversalis fascia with a documented recurrence rate of 0.4% and warranty for a lifetime.