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22Wojciech Szczęsny et al.Those in favor of laparoscopy stress swift rehabilitationand diminished pain after these procedures (importante.g. in sportsmen). However, the procedurecarries a risk of typical laparoscopy complications(including fatal ones) and requires general anesthesia.The problem is subject to discussion [27 ].Laparoscopic techniques are also used in postoperativeand 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 and the relationships withinthe inguinal canal was low. The greatest advances inunderstanding the anatomical foundations of herniaformation took place in the XVIII th and XIX th centuries.Even though the anatomical and 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 and 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 andgenetic 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 and be gene-related. Thealterations include disrupted synthesis and maturationof collagen and 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,and the research continues. According to contemporarytheories, hernias have a complex etiology, definitelyincluding congenital factors, concerning connectivetissue structure and 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% and, 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, and 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, and 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 and otherdiastases.J.A.M.A. 1901;37;1162–1165.13. Desarda MP. New method of inguinal hernia repair: A