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The history and the present of herniology 21postoperative hernia repair. [23]The problem of recurrent and bilateral hernia repairhas remained unsolved for many years. Repeated operationsusing the same approach did not work underaltered anatomical conditions among weakened tissues.Lichtenstein’s and Rutkow’s repairs are two representativesof „tension-free” inguinal hernia repair (flatand 3D implant, respectively). A third tension-freemethod has been described by Rene Stoppa, a Frenchsurgeon. In 1975 he reported a series of cases of recurrenthernias repaired with the use of Dacron mesh. Theimportant difference lay in a completely differentchoice of approach to the hernial defect. The preperitonealspace was accessed via an inferior midline incision,The contents of the hernial sac were reduced intothe abdominal cavity, giving excellent view of thedefect, which was then covered by a relatively largeimplant, covering both musculopectineal orifices. Thechevron-shaped mesh secured the area of the surgicalincision as well. It was fixed in place in 2-3 places onlyto prevent folding, the main force fixating the mesh inplace being the abdominal pump, acting according toPascal’s law. The preperitoneal space proved to be theideal location for the implant. Mesh placement in aspace unaccessed during previous repair attempts wasan excellent solution especially for patients with numerousrecurrencies [24 ].Even though preperitoneal repairs evoke the nameof Stoppa, the history of this approach is longer. It wasprobably first used by Thomas Annandale of Edinburghin 1876. Two reports exist of operations utilizingthis approach as early as 1743 [2]. The idea was revisitedin early 1900’s in the USA. Cheatle performedoperations using the midline incision in the Trendelenburgposition in 1920. After separating the rectus muscles,he dissected the peritoneum off the anterior pelvicwall and bladder, reduced the contents of the hernia tothe abdominal cavity, leaving a part of the transectedsac in the inguinal canal, and partially closed the deepring. He used this approach on inguinal and femoralhernias. Cheatle also utilized the Pfannenstiel incision.His ideas were popularized by A. Henry. The preperitonealapproach gained popularity in the 1950’s in theUSA. Mc Evedy utilized an oblique incision within therectus sheath, gaining excellent view of the preperitonealspace. Read and McVay also operated in thisfashion, but it was Nyhus who performed thoroughanatomical and clinical research on the subject. In 1959he was the first to use a synthetic implant via apreperitoneal approach. His idea was further developedby Rignault and Stoppa [25 ].In spite of the successful introduction of syntheticmaterials into hernia surgery in the latter half of theXX th century, „pure tissue repair” techniques were notabandoned. The most well-known of these, besidesBassini’s repair which remained to be used and modified,was Shouldice’s method, known as “Canadianrepair”. Developed in the early 1950’s, this techniquewas perfected in Shouldice’s clinic, where the recurrentrates did not exceed 2%. In other centers the resultswere less spectacular, and the technique is considereddifficult to perform. In many other centers –including Polish ones – tension methods such as Bassini’s,Halsted’s and others are still used [ 26].A remarkable method has been proposed by theabove-mentioned M. Desarda. He used a deep externaloblique aponeurosis as a natural “mesh”. The resultsgiven by the author and confirmed by our Departmentseem favorable [13].The wonderful development of videosurgery didnot omit hernia surgery. The concept of intraperitonealapproach to inguinal hernia has been conceived in thelate 1970’s at the Albert Einstein College of Medicinein the USA. The idea was based on the reduction ofhernial defect size by clips in order to prevent the migrationof the viscera into the inguinal canal. Initialresults, performed during laparotomy for unrelateddiseases, appeared inviting. At that time, the laparoscopictechniques were insufficiently developed toallow hernia repair. A series of procedures performedin 1982 was less successful. Bogojavlenski initiatedlaparoscopic hernia treatment in 1989, using a syntheticmesh. The development of this technique wasagain halted by the lack of proper equipment. In 1990,Schultz introduced a technique of plug insertion intothe deep ring after a peritoneal incision. The implantwas not fixed in place and the recurrence rates after 2years reached 25%. Therefore, the technique evolvedtoward larger implants fixated by clips. Early experienceswith the onlay technique were equally poor (intestinaladhesions and recurrences) and it is infrequentlyused today. Contemporarily, two techniques oflaparoscopic herniotomy are used: TAPP (transabdominalpreperitoneal) in which the mesh is placedunder the peritoneum and TEPA (total extraperitonealapproach) – in which the preperitoneal space is dissectedby a special balloon device anda mesh placed there. The laparoscopic approach, particularlythe TEPA technique, is a development of theclassical Stoppa technique [2].