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This article aims to analyze the types of surgical diseases and treatments in ancient China as documented in bamboo and silk texts, with a particular focus on (external) injury, tetanus, burns, rectal and anal diseases, and inguinal hernias. For this analysis, I gathered 85 instances of disease and treatments recorded in these texts. The 85 cases were further categorized into 13 (external) injuries, 13 metal wounds, 6 tetanus, 22 burns, 16 rectal and anal diseases, and 15 inguinal hernias. The analysis revealed that the treatment of (external) injury and burns focused primarily on the wound site, while the treatment of metal wounds and tetanus centered on addressing the internal body. Internal treatments were mainly prescribed through the use of medicine and food. Surgical intervention was recommended primarily for diseases of the rectum and anus, with medications applied to the woundspost-surgery. For inguinal hernias, a high-protein diet was typically prescribed. As we've seen, in ancient China, surgical diseases were mainly treated with medication, surgery, and dietary prescriptions. And among these prescriptions, drug prescriptions were utilized not only by medical doctors but also by witch-doctors treating diseases in civilian society and soldiers stationed at frontline military posts. In the absence of medical doctors in both civilian society and frontline units, witch-doctors and frontline units purchased or stockpiled prescription drugs and used them to treat patients according to prescription.

General Douglas MacArthur was a towering public figure on an international stage for the first half of the 20th century. He was healthy throughout his life but developed a series of medical problems when he entered his 80s. This article reviews the General's medical care during two separate life-threatening medical crises that required surgical intervention. The first episode occurred in 1960 when MacArthur presented with renal failure due to an obstructed prostate. Four years later after his 84th birthday, MacArthur developed bile duct obstruction from common duct stones. He underwent an uncomplicated cholecystectomy and common duct exploration but developed variceal bleeding requiring an emergent splenorenal shunt. His terminal event was precipitated by strangulated bowel in long-ignored very large inguinal hernias. MacArthur died, despite state-of-the-art surgical intervention, due to renal failure and hepatic coma.

Stoppa method - forgotten surgery.

A brief history of the seminal contributions of Stoppa and Nyhus to inguinal hernia surgery., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Unlabelled: The history of groin hernia surgery is as long as the history of surgery. For many centuries doctors, anatomists and surgeons have been devoted to this pathology, afflicting the mankind throughout its evolution. Since ancient times the Italian contribution has been very important with many representative personalities. Authors, investigators and pioneers are really well represented. Every period (the classic period, the Middle Age, the Renaissance and the post-Renaissance) opened new perspectives for a better understanding. During the 18th century, more information about groin anatomy, mainly due to Antonio Scarpa, prepared the Bassini revolution. Edoardo Bassini developed the first modern anatomically based hernia repair. This procedure spread worldwide becoming the most performed surgical technique. After World War II synthetic meshes were introduced and a new era has begun for hernia repair, once again with the support of Italian surgeons, first of all Ermanno Trabucco. But Italian contribution extends also to educational, with the first national school for abdominal wall surgery starting in Rome, and to Italian participation and support in international scientific societies. Authors hereby wish to resume this long history highlighting the "made in Italy" for groin hernia surgery., Key Words: Bassini, Groin hernia, History, Prosthetic repair.

Sant'Ippazio (St. Hypatius of Gangra) is a saint, martyr, and advocate in cases of impotency, inguinal hernia, and other abdominal disorders. In Tiggiano, a small town at the southernmost point of Italy, Sant'Ippazio, bishop of Gangra, is venerated as a patron saint. According to legend, during an excited dispute on the question of the Arian heresy at the synod of Nicaea (325 AD), Bishop Ippazio was kicked in the lower abdominal region by an Arian presbyter, which caused an inguinal hernia. Therefore, his help is sought for relief and cure of hernia or impotency. Every January 19th, the day of the parish fair, particular carrots (the "pastinache") which have a reddish to violet color are sold. They are said to be similar to the saint's penis after the kick. Also described in this article are other pagan fertility rituals which have been christianized by the veneration of a saint and which are still kept alive among local populations.

Preperitoneal approaches to the repair of primary, bilateral, recurrent, inguinal, and femoral herniae, the most common abdominal protrusions, now dominate techniques of repair. The purpose of this review is to outline crucial steps which have led to this result. Abernethy (Surgical cases and remarks. Of the operation for the aneurysm. Cadell and Davies (Strand), London, pp. 149-176, 1797) introduced an operation to treat aneurysms of the external iliac artery, which was endorsed by Cooper (The anatomy and surgical treatment of abdominal hernia. Longman and Co, London, 1804). Bogros (Essai sur l'anatomie chirurgical de la region iliac et description d'un nouveau procede pour faire la ligature des arteries epigastric et iliaque externe. Th. Paris, no. 153. A Paris, de l'imprimerie de Didot le Jeune, imprimeur de la Faculte de Medicine, rue des Macons, Sorbonne no. 13, 1823) described his preperitoneal space which continues into the suprapubic space of Retzius. Annandale (Edinb Med J 21:1087-1091, 1876) initiated anterior preperitoneal repair. Cheatle (Br Med J 2:68-69, 1920, Br Med J 2:1025-1026, 1921) demonstrated the median posterior preperitoneal approach, resurrected by Henry (Lancet 1:531-533, 1936). McEvedy (Ann R Coll Surg Engl 7:484-496, 1950) modified the Cheatle-Henry procedure by using a unilateral oblique incision in the rectus sheath and underlying transversalis fascia with medial retraction of the rectus muscle. Estrin et al. (Surg Gynecol Obstet 116:547-550, 1963) reinforced this repair with prostheses attached to Cooper's ligament, thereby, eliminating tension. Anterior prosthetic preperitoneal repair was introduced by Usher et al. (Am Surg 24:969-974, 1958) using polyethylene and, later, polypropylene meshes which were not slit, since the spermatic cord was lateralized. Stoppa et al., beginning in 1965, performed giant prosthetic reinforcement of the visceral sac, covering Fruchaud's myopectineal orifice preperitoneally with extensive overlap. They used a posterior approach to avoid scarring in recurrent cases and to allow the exposure of large, bilateral, inguinal, and femoral sacs (Rev Med Picardie 1:46-46, 1972). Wantz (Surg Gynecol Obstet, 169:408-417, 1989) proposed a unilateral version. Gilbert (Am J Surg 163:331-335, 1992) described the anterior preperitoneal sutureless repair of groin herniation. He employed a two-layered prosthesis, the upper resting on the transversalis fascia, the lower in the space of Bogros. They were connected by a plug passed through the internal inguinal ring. Kugel (Am J Surg 178:298-302, 1999) described his anterior preperitoneal prosthetic repair of groin herniation through an abdominal gridiron incision. Laparoscopic repair of groin protrusions began in 1982 (Ger; Ann R Coll Surg Engl 64:342-344, 1982). In 1992, Arregui et al. (Surg Laparosc Endosc 2:53-58, 1992) and Dion and Morin (Can J Surg 35:209-212, 1992) reported on their transabdominal preperitoneal (TAPP) approach. To avoid intraperitoneal complications, Dulucq (Cahiers Chir 79:15-16, 1991) recommended a totally extraperitoneal (TEP) approach. These techniques incur fewer recurrences than open techniques and diminish postoperative pain. However, the operating time is longer, they are more expensive, and special skills are needed. In addition, general anesthesia is required. Thus, late in the 18th century, surgeons began incising the groin to treat aneurysms there. This experience led to the discovery of the preperitoneal space of Bogros, which, in the 1870 s, was employed for the anterior repair of groin herniation. The posterior preperitoneal approach became established in the 1920s-1960s, along with the use of prostheses. Laparoscopy was applied near the end of the century.

Background: Inguinal hernia repair may be the most common procedure in general surgery. Many repairs have been described but none appears completely satisfactory. A brief look at the popular methods of repair from the traditional tissue approximation to the current mesh-based techniques is presented., Methods: The PubMed database was searched for all English language literature. Further references were obtained through cross-referencing the bibliography cited in each work and using books from the authors' collection., Conclusion: The history of inguinal hernia is a rich one, from the traditional tissue approximation techniques to the current mesh-based repairs which are now performed as open or laparoscopic procedures. Recurrent rates have reduced but are still a problem. Perhaps the perfect repair remains elusive because the problem may also be with patients' collagen not just the surgical procedure.

Introduction: Despite herniorrhaphy being performed frequently, most surgeons consider it to be a minor procedure. However, a few surgeons' views differed., The Past: The Master was Bassini (1884), who introduced a radical cure for inguinal hernia. Incising his triple layer, internal oblique, transversus, and transversalis, he entered the preperitoneal space, allowing high ligation of the sac and mass suturing to the inguinal ligament. A 2.7% recurrence rate evoked worldwide emulation. Corruption ensued. The cremaster remained and few unincised layers were stitched, without imbrications, along with reinforcement using the cremaster or rectus muscles, fascial flaps, relaxing incisions, and silver coils. Little improvement cast doubt on Bassini's work. Russell's (Lancet 2:1197-1203, 1906) ligation of the hernial sac was adopted until 1953, when the Shouldice clinic revived Bassini's tenets, becoming the gold standard for decades. Cheatle (Br Med J 2:68-69, 1920) introduced posterior pre-peritoneal repair. Acquaviva and Bourret (Presse Med 73:892, 1948) designed the first plastic prosthesis (nylon), replaced by polypropylene. Usher (Surg Gynecol Obstet 117:239-240, 1963) parietalized the cord. These contributions paved the way for the Rives, Stoppa, Wantz, and Gilbert repairs, Ger's laparoscopic approach, and less common herniorrhaphies., The Present: Chevrel (1979) formed the GREPA, which evolved into the European Hernia Society (EHS), joining with the American Hernia Society (AHS) to form the journal 'Hernia.' Nilsson (1993) instituted national hernia registries, enabling less recurrences and better prospective research., The Future: In the 21st century, the Lichtenstein procedure has dominated inguinal herniorrhaphy. Herniologists accepted systemic connective tissue disorder as the etiology of abdominal hernia and pelvic prolapses. This malady explains why prostheses slow but do not eliminate recurrence. Antidotes need to be developed and employed., Conclusion: This malady explains why prostheses slow but do not eliminate recurrence. Antidotes need to be developed and employed.

The first description of the transabdominal approach for hernia repair was written by Demetrius Cantemir, Prince of Moldavia and encyclopedic scholar, in his 1716 Latin manuscript "Incrementa et decrementa Aulae Othomaniae" ("The history of the Growth and Decay of the Ottoman Empire"). This manuscript was one of the most important in Eastern Europe at the time. It was first translated in English in 1734 by N. Tyndal, and all subsequent translations into various other languages were based on this english version. The original manuscript now belongs to the Houghton Library of Harvard University, where it was recently discovered in 1984 by V. Candea. Our article presents for the first time the complete account of the surgical procedure performed by Albanian physicians in the prince's palace in Constantinopol. The patient was the Prince's secretary. There is a detailed description of the operation, postoperative therapy and the medical course to recovery. The text presented is translated in English from Annotations of Volume Two, chapter four. We consider it worthwhile to present to the medical community this valuable but less known contribution to the history of medicine.

The famous Dutch medical doctor Petrus Camper (1722-1789) was appointed professor of anatomy and surgery at the University of Franeker, Amsterdam, and Groningen. As Praelector Anatomiae of the Amsterdam Guild of Surgeons, he gave public anatomy lessons in the Anatomy theatre in Amsterdam. During the mid 18th century he performed dissections on corpses of children and adults to investigate the anatomy and etiology of inguinal hernias. The concept that a hernia was caused by "a rupture of the peritoneum" was common at that time. Camper concluded that this was incorrect and provided a clear description of the etiology of hernias in children and adults. For the treatment of inguinal hernias, he designed a truss based on the geometrical proportions of the pelvis. This "truss of Camper" was much used and internationally renowned. His anatomical studies and perfect, self-drawn illustrations contributed to a better understanding of the anatomy of the inguinal canal, on the national as well as international level. Camper's "Icones Herniarum" is his most widely known work on inguinal hernias and included a series of outstanding anatomical illustrations. Petrus Camper should be considered one of the pioneers in the field of inguinal hernias.

The first description of the transabdominal approach for hernia repair was written by Demetrius Cantemir, Prince of Moldavia and encyclopedic scholar, in his 1716 Latin manuscript "Incrementa et Decrementa Aulae Othmanicae". This manuscript was one of the most important of Eastern Europe at the time. It was first translated in English in 1734, and all subsequent translations into various other languages were based on this English version. The original manuscript now belongs to the Houghton Library of Harvard University, where it was recently rediscovered in 1984 by V. Candea. D. Sluşanschi has made the first Romanian translation of the first two volumes based on the original latin manuscript. This translation is now in press. Our article presents for the first time a fragment of this Romanian translation from the Annotations of Volume two, chapter four. In this fragment, Demetrius Cantemir describes the surgical procedure practiced by Albanian physicians in the prince's palace in Constantinopol. The patient was the secretary of the prince. There is a detailed description of the postsurgical therapy and the medical course to recovery. It was first partially reproduced by Mercy in his book on hernia published in 1892, and more recently by Meade in 1965. We consider useful to present to the medical community this valuable but less known contribution to the history of medicine.

Hernia (Greek kele/hernios--bud or offshoot) was present in the human history from its very beginning. The role of surgery was restricted to the treatment of huge umbilical and groin hernias and life-threatening incarcerated hernias. The treatment of groin hernia can be divided into five eras. The oldest epoch was ancient era from ancient Egypt to 15th century. The Egyptian Papirus of Ebers contains description of a hernia: swelling that comes out during coughing. Most essential knowledge concerning hernias in ancient times derives from Galen. This knowledge with minor modifications was valid during Middle Ages and eventually in the Renaissance the second era of hernia treatment began. Herniology flourished mainly due to many anatomical discoveries. In spite of many important discoveries from 18th to 19th century the treatment results were still unsatisfactory. Astley Cooper stated that no disease treated surgically involves from surgeon so broad knowledge and skills as hernia and its many variants. Introduction of anesthesia and antiseptic procedures constituted the beginning of modern hernia surgery known as era of hernia repair under tension (19th to middle 20th century). Three substantial rules were introduced to hernia repair technique: antiseptic and aseptic procedures. high ligation of hernia sac and narrowing of the internal inguinal ring. In spite of the progress the treatment results were poor. Recurrence rate during four years was ca. 100% and postoperative mortality gained even 7%. The treatment results were satisfactory after new surgical technique described by Bassini was implemented. Bassini introduced the next rule of hernia repair ie. reconstruction of the posterior wall of inguinal canal. The next landmark in inguinal hernia surgery was the method described by Canadian surgeon E. Shouldice. He proposed imbrication of the transverse fascia and strengthening of the posterior wall of inguinal canal by four layers of fasciae and aponeuroses of oblique muscles. These modifications decreased recurrence rate to 3%. The next epoch in the history of hernia surgery lasting to present days is referred to as era of tensionless hernia repair. The tension of sutured layers was reduced by incisions of the rectal abdominal muscle sheath or using of foreign materials. The turning point in hernia surgery was discovery of synthetic polymers by Carothers in 1935. The first tensionless technique described by Lichtenstein was based on strengthening of the posterior wall of inguinal canal with prosthetic material. Lichtenstein published the data on 1,000 operations with Marlex mesh without any recurrence in 5 years after surgery. Thus fifth rule of groin hernia repair was introduced--tensionless repair. Another treatment method was popularized by Rene Stoppa, who used Dacron mesh situated in preperitoneal space without fixing sutures. First such operation was performed in 1975, and reported recurrence rates were quite low (1.4%). The next type of repair procedure was sticking of a synthetic plug into inguinal canal. Lichtenstein in 1968 used Marlex mesh plug (in shape of a cigarette) in the treatment of inguinal and femoral hernias. The mesh was fixated with single sutures. The next step was introduction of a Prolene Hernia System which enabled repair of the tissue defect in three spaces: preperitoneal, above transverse fascia and inside inguinal canal. Laproscopic treatment of groin hernias began in 20th century. The first laparoscopic procedure was performed by P. Fletcher in 1979. In 1990 Schultz plugged inguinal canal with polypropylene mesh. Later such methods like TAPP and TEP were introduced. The disadvantages of laparoscopic approach were: high cost and risk connected with general anesthesia. In conclusion it may be stated that history of groin hernia repair evolved from life-saving procedures in case of incarcerated hernias to elective operations performed within the limits of 1 day surgery.

Late into the 19th century, treatment for inguinal hernias consisted of repositioning the hernia with trusses or using 'softening agents' such as warm herbal baths and moist bandages. Surgical resection or cauterisation, often combined with hemicastration, was only considered for cases ofstrangulated hernia that could not be repositioned. Bassini (1844-1924) is credited with developing the precursor to the modern inguinal hernia operation at the end of the 19th century. Bassini's essential discovery was that the transverse fascia plays a key role in the pathophysiology of inguinal hernias. Bassini's operation, consisting of complete incision of the transverse fascia and reconstruction of the inguinal floor, was considered the gold standard for nearly a century. One problem with the conventional Bassini operation was the tension applied to tissues, which led to a high rate of recurrence. Although Bassini's operation has now become obsolete, current surgical approaches still centre on fortification of the inguinal floor. This tension-free repair now uses synthetic mesh that is positioned using an open anterior approach, laparoscopic surgery, or a preperitoneal technique.

Hernias were prevalent among servicemen, typically recruited from amongst the malnourished. Civilian medical practice deemed the rupture incurable, taking a palliative approach. For the military this was unacceptable: wastage rates due to ruptures were high, servicemen were valuable commodities. Examples here are used to illustrate that experimentation was a contentious activity, reliant on the whims of patronage and war-time budgets. Although military hospitals provided a good venue to engage in experimentation it was contested.

Relaxing incisions (Wolfler 1892) were eventually shown (Read and McLeod, 1981) to reduce but not eliminate wound tension after sutured herniorrhaphy of the groin. Reinforcing prosthetics became widely shunned because of morbidity until Usher et al (1958) introduced polyethylene, then polypropylene mesh (1963) for preperitoneal tensionless repair of large defects. Excellent long-term results were obtained, with his technique, by Collier and Griswold (1967). Patt (1967) envisaged its application to primary hernia. Reis (1899) introduced early ambulation. However, it was not until Leithauser (1943), Blodgett (1946), and others showed immediate rising accelerated wound healing and reduced complications that Farquharson (1955) began outpatient hernioplasty (in 1950) under local anesthesia (Cushing 1900). Bellis (1964) followed, performing tensionless repair in 25%. Rodriguez and Phillips (1967) described office herniorrhaphy, 30% undergoing polypropylene mesh coverage without tension. Lichtenstein (1970) reported mesh onlay reinforcement for sutured repair of large defects, discharge was within 24 hours. Martin et al (1982) began (in 1972) to treat all inguinal herniation in adults with polypropylene mesh "to avoid recurrences". Newman did likewise, using tension-free placement (Rodriguez et al) in the subaponeurotic plane. Encountering resistance to publication ("real surgeons don't use mesh") he, in 1980, asked Lichtenstein to publish and popularize the technique. Kelly (1898) introduced plug prosthestic repair of femoral herniation. Drainer and Reid (1972) used polypropylene mesh from below under local anesthesia. Lichtenstein and Shore followed, treating recurrent inguinal defects similarly. Gilbert (1989) applied the technique to indirect herniae. Usher and others deserve recognition for their contributions to the elimination of tension from herniorrhaphy.

Currently, operative repair of inguinal hernia is most often performed using one of the open mesh procedures or laparoscopic techniques. These newer approaches minimize anatomical dissection critical to the time-honored traditional hernia surgery described by Bassini, Halsted, McVay, Laroque, Shouldice, and other early pioneers. The familiarity with groin anatomy and the technical skill gained in performing these operations is currently missing from present-day surgical residency training. This article reviews 5 classic hernia operations described by the surgeons whose name they bear, with a view toward better understanding the authors' techniques and philosophies. Each of these operations, though considered by some as of historical interest only, offers today's surgeon reliable alternatives when the simple application of mesh by open or laparoscopic technique is inappropriate. (Curr Surg 62:249-252. Published by Elsevier Inc. on behalf of the Association of Program Directors in Surgery.).

Traditional disdain for groin repair stifled recognition of British innovations. Some, relating to modern herniology, are remembered herein. Morton (1841) and Mackay (1889) showed the epigastric artery piercing Cooper's transversalis fascia (1807). Bilaminarity (Cooper, 1807) was confirmed in 1992 (Read). Thomson's iliopubic tract (1838) became part of Nyhus' repair (1960) [derived from McEvedy's repair (1950)] and laparoscopy (Ger, 1982). Retzius' space (Edinburgh, 1858) with Lister's antisepsis (1865) enabled preperitoneal herniorrhaphy (Annandale, 1876). He participated (1873) in intraperitoneal release of incarceration and reducible protrusions (Tait 1883). Cheyne's pectineus muscle plug (1893) preceded Kelly's marble prosthesis for femoral herniation (1898). Cheatle (1920) introduced posterior preperitoneal repair-ignored, rediscovered (Henry, 1936), and adopted (1952) at the Mayo clinic. Calne (1967) pioneered retrorectus Mersilene and was followed by Stoppa (1969) and Wantz (1989). Brandon (1945) blamed failure of modified Bassini's herniorrhaphies on closure at the intermediate inguinal ring instead of the internal. A similar mechanism may explain interstitial recurrence (Gilbert, 2003) after Amid-Lichtenstein repair. Lytle (1896-1986) described a muscle shutter at the internal ring, course of genitofemoral nerve, and orifice of femoral canal. Russell's congenital saccular theory (1906) was questioned by Keith (1924). Acquired connective-tissue pathology was later shown to play a systematic role in adult groin herniation (Read, 1970), confirmed by Jackson and colleagues (1996) and others.

Edoardo Bassini, an Italian surgeon active at the turn of the 19th century, made a lasting contribution to surgery with his elucidation of the cure for inguinal hernia. The magnitude of this contribution in contrast to centuries of frustration in attempting surgical repair of hernia is described, as are Bassini's personal experiences, which may have played a role in his successful search for a cure.

The aim of this article is to present the techniques applied by Byzantine physicians for inguinal hernia repair and to note their influence on the development of surgery after that time. A study and analysis of the original texts of the Byzantine medical writers, written in Greek, and containing the now mostly lost knowledge of the ancient Hellenistic and Roman periods, was undertaken. Two Byzantine physicians, Aetius of Amida (6th century A.D.) and Paul of Aegina (7th century A.D.), described two techniques for confrontation of inguinal hernia, namely the surgical removal of the prolapsed peritoneum and the cauterization of the groin. These methods were probably derived from the texts of earlier Greek surgeons to which they added their own keen observations. The study of Byzantine medical and literary texts proves that the surgical techniques for inguinal hernia were practiced in Byzantine times and influenced later Arabian and European surgery, thus constituting significant roots of surgery.

Hernia (know breuk in Dutch, rompure in French, keal in Greek and rupture in English) has plagued humans throughout recorded history and descriptions of hernia reduction date back to the Ebers papyrus in Egypt. In medicine it is difficult to find historical periods, but we found two eras of uneven time: pre-technique and technique. The first was distinguished by a blend of empiricism and magic, and the second for greater comprehension of the human body; however much of modern surgical techniques result from contributions of early surgeons. Nonetheless, it was not until the late 19th century that hernia surgeon Eduardo Bassini published his work Nuovo Metodo per la Cura Radiacale dell"Ernia Inguinale (in 1889). Among the most notable contemporany classic hernia repairs are the Bassini, Halsted, Shouldice, and Tension-free repair techniques.

The history of open surgery for groin hernia has gone through many stages of development, including the ancient era (ancient times to the fifteenth century), the era of the start of herniology (fifteenth to seventeenth centuries), the anatomic era (seventeenth to nineteenth centuries), the era of repair under tension (nineteenth to mid-twentieth century), and the era of tensionless repair (mid-twentieth century to the present). Five principles of modern hernia repair developed through these periods of development: antiseptic/aseptic hernia operation, high ligation of the sac, tightening of the internal ring, reconstruction of the posterior inguinal floor, and tensionless repair. Interestingly, many of the initial attempts at laparoscopic hernia repair did not adhere to the recognized principles of hernia surgery learned from open surgery. It is only when the transabdominal preperitoneal mesh repair and the totally extraperitoneal approach, which adhere to the basic principles, are considered that the results of laparoscopic hernia repair procedures can improve and the recurrence of hernia decrease.

This subject has been well covered in recent years. Yet it seems appropriate to search for major advances in hernia methodology during the last 100 years. Eduardo Bassini is credited with pioneering the modern era. His "triple layer" repair was corrupted through the years and, as a result, he did not receive sufficient credit for his attention to the posterior inguinal wall. Chester McVay, renowned surgeon-anatomist, renewed interest in the Cooper's ligament and the posterior inguinal wall. Surgeons from the Universities of Washington and Illinois perfected approaches to the posterior inguinal wall. Thus, these investigators paved the way for several effective posterior hernia operations. The name of Usher will forever be remembered in terms of practical prosthetic mesh (polypropylene). This material, as well as others, has become an important addition to the surgeon's armamentarium. Rene Stoppa reminded us of the Pascal principle and clearly demonstrated how giant prostheses can remain in the preperitoneal space without the need for sutures. Tension-free operations, plug techniques, and laparoscopic hernia methodology must await further analysis.

At the dawn of the third millennium, the aim of this brief historical review was to trace the evolution of the surgical management of hernias during the recent past centuries after the advent of true anatomical knowledge. Because it is a frequent and ubiquitous surgery, many surgeons have devised new techniques in order to perform more and more efficient procedures, suitable to the patients' demands, the health care economy and quality care control.

Objective: To describe the clinical recognition, pathology, and management of Richter's hernia and to review the relevant literature of the past 400 years., Summary Background Data: The earliest known reported case of Richter's hernia occurred in 1598 and was described by Fabricius Hildanus. The first scientific description of this particular hernia was given by August Gottlob Richter in 1778, who presented it as "the small rupture." In 1887, Sir Frederick Treves gave an excellent overview on the topic and proposed the title "Richter's hernia." To his work-a cornerstone to modern understanding-hardly any new aspects can be added today. Since then, only occasional case reports or small series of retrospectively collected Richter's hernias have been published., Methods: The authors draw on their experience with 18 prospectively collected cases treated in the ICRC Lopiding Hospital for War Surgery in northern Kenya between February and December 1998 and review the relevant literature of the past 400 years., Results: The classic features of Richter's hernia were confirmed in all case studies of patients: only part of the circumference of the bowel is entrapped and strangulated in the hernial orifice. The involved segment may rapidly pass into gangrene, yet signs of intestinal obstruction are often absent. The death rate in the authors' collective was 17%., Conclusion: Richter's hernia is a deceptive entity whose high death rate can be reduced by accurate diagnosis and early surgery. Considering the increasing incidence at laparoscope insertion sites, awareness of this special type of hernia with its misleading clinical appearance is important and of general interest.

This paper makes a small contribution to a more detailed knowledge of the history of Italian surgery. Few know that Italy can boast a category of surgeons who should be regarded as the world forebears of modern surgery. These skilled individuals are better known as "Norcini", a term which is often regarded as negative and contemptible. However, in practice, they came from Preci and were only called "Norcini" because their village formed part of the "contado" of Norcia. Preci still possesses a large collection of surgical instruments and other items which testify how the art of surgery developed from this small centre. Extensive research has led to the reconstruction of a general picture of this phenomenon and its influence in Italy and throughout the world. These surgeons were the only ones capable of operating gallstones, cataracts and inguinal hernia. They developed specific instruments and were the first to introduce cauterization and narcosis. The latter enabled them to overcome almost all the factors which limited surgery at the time, namely infection, pain and hemorrhage. This study attempts to explain how and why such skillful surgeons were to be found in such a small and isolated area of Umbria.

Since the introduction of the term "fascia transversalis" by Sir Ashley Cooper in 1840, this thin layer of tissue has been discovered, denied, and redefined. The transversalis fascia was originally described as a bilaminar membrane. Although most subsequent descriptions do not reflect this analysis, some authors, especially in the surgical literature, believe that a posterior lamina of the transversalis fascia exists. Others believe that the posterior lamina of the transversalis fascia is, in fact, part of the preperitoneal fascia. The usefulness of the transversalis fascia and its derivatives or analogues; e.g., the crura of the deep inguinal ring, have also been extensively discussed. The aim of this paper is to provide a brief survey of the historical literature concerning the transversalis fascia and a discussion of some of the contemporary views on its morphology and significance in current laparoscopic hernia repair.

One of the most important eras in the evolution of groin hernia surgery is that of the early 19th century. It was a time when cadaver dissections and diverse clinical studies culminated in a more thorough anatomic understanding of the inguinal canal. For reasons cloaked in permanent historical uncertainty, the style of hernia textbook publishing also dramatically changed at the turn of the 19th century when sumptuous anatomical atlases, exemplified by those of Astley Cooper, Franz Hesselbach, Antonio Scarpa, and Jules-Germain Cloquet, began to appear. Characterized by the presence of numerous detailed engravings these texts were expensive to publish and often had limited print runs. The publishing history and clinical impact of these now rare hernia tomes are analyzed in this article.

The history of the surgical treatment of groin hernias is reviewed with emphasis on the events leading to the introduction and development of the management of these hernias by a laparoscopic approach. The reasons for a shift from an inguinal to an abdominal approach are presented, and the early results of the latter are considered together with the possible advantages and disadvantages. Both methods rely on the use of small or large pieces of mesh that replace the previous bulwark of hernia repairs, namely the rearrangement of tissue layers. Currently, the challenge of the laparoscopic approach is being met by those espousing the inguinal approach.