Page 7 - herina surgery and possible lawsuits

without slit in it, for repair of difficult groin hernias using a prepentoneal approach
via a low midline incision. [26] He reported that properly placed mesh in the
prepentoneal space acts as artificial non absorbable endoabdominal fascia, making the

abdominal wall instantly and definitely pressure-tight and hernia-resistant. [10]

• Mesh plugs were introduced by Irving Lichtenstein m 1968 by using a rolled
cylindrical or "cigarette" Marlex mesh plug for treatment of femoral and recurrent
inguinal hernias.

In 1987, Bendavid devised a clever umbrella-shaped Marlex prosthesis for femoral
hernia to be inserted from below into the prepentoneal space. He also described three-

leafed "Fletching" mesh prosthesis for reconstruction of the groin floor. Around same
time Arthur Gilbert also have introduce his plug.

In 1989, Rutkow and Robbins began using hand-fashioned "umbrella" plug which
was later on commercially produced as ‘PerFix’ by C.R. Bard Company.[10]

In 1914 by Sir Francis Darwin, the son of Charles Darwin made statement that “In science,
the credit goes to the man who convinces the world, not to the man to whom the idea first
occurs’’’l 9]

• Lichtenstein popularized Meshplasty as a common concept for all the hernias m
1989. He introduced the current concept of the “tension free” polypropylene mesh

repair, as an office procedure under local anesthesia, into everyday common practice.
He also pioneered the idea that hernia surgery is special and it must be performed by an

experienced surgeon and float the concept" Herniology”, which had lead a major shift
towards use of prosthesis. ;

Thus, the fifth principle was established.
I
Laparoscopic hernia repairs

The first laparoscopic surgery for hernia was a closure of the neck of the sac done by P.
Fletcher (1979, West Indies).
• Ger in 1982, first reported laparoscopic operation to close the neck of sac using a

Michel clip, which did not have good result as there was no attempt to repair the
posterior inguinal floor, but have gradually given way to attempts to repair the hernial

defect. [10]
• Arregui in 1991, introduced TAPP (transabdommal preperitoneal repair).

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