According to the evolution of hernia surgery, it can be easier to understand:
Traditional natural tissue stitching methods can be divided into 2D (Bassini) and 3D (Shouldice):
In the 18th century, the 2D hernia surgery invented by Dr. Bassini was a great invention compared to the previous historical method of using a hernia sac for compression. In the Middle Ages, fire tongs were even used to burn the wound and close the groin. The 2D hernia surgery enabled systematic repair of most hernias, but the long-term recurrence rate was as high as 5~10% due to the 2D structure. It wasn’t until the 1940s and 1950s when Canadian military doctor, Dr. Shouldice invented “Shouldice” hernia surgery, which is a 3D reconstruction, in order to reduce the recurrence of hernia in draftees whom the recurrence of hernia causes them to be unable to participate in the war. The recurrence rate was reduced to about 1%, and gradually became the gold standard for global hernia surgery. However, 3D reconstruction is complicated, and it involved personal experience of the doctor. Although the recurrence rate was low, most non-specialized hernia surgeons could not accumulate experience easily, so they continued to use 2D suturing or resulting the different recurrent rate. In the 1990s, because of the invention of the synthetic plastic propylopelene, it began to be used in hernia surgery. The recurrence rate of 2D reconstruction with mesh patch declined to 2~3%, and the operation was simple. Therefore, it was heavily used by most non-specialized hernia surgeons. In the 2000s, with the development in the technology of laparoscopic minimally invasive devices, surgeons further gained the ability to drill holes from a distance, from the abdominal cavity or the anterior layer of the abdominal cavity, to the posterior layer of the abdominal wall muscles to patch the mesh, attempting to be deep in the inner layer to reduce the complexity of entering from the anterior. However, there are limitations due to several problems (1) since the mesh can only be used to patch on the weak spot of muscle layer of the abdominal wall from the posterior, it cannot be used for suturing the 2D muscle layer, only relying on the mesh to resist abdominal pressure. (2) It is limited by potential weak spots such as fat-type hernia protrusion of anterior layer that are difficult to treat. (3) When stitching the mesh on posterior layer, it is necessary to avoid important tissues such as large blood vessels and nerves. It is not easy to completely pave and set the mesh. (4) It is impossible to detect the weak spot and tension of the structure of muscle layer with a laparoscopic device, and it is possible that a potential recurrence spot will be left out and the mechanical structure of the repair is uneven. The factors above cause the recurrence rate of hernia in laparoscopic surgery to be 3 to 7%, plus due to the need for general anesthesia with tracheal intubation, the risk of anesthesia is higher, and the abdominal cavity or the peritoneal anterior layer must be injected with carbon dioxide to support operation space. There may be postoperative abdominal muscle pain and increased risk of anesthesia.
“The Integrative Hernioplasty” can achieve deep leveling and 3D reconstruction of hernia surgery with a small, minimally invasive incision (about 3-4 cm for men and 1.5-2 cm for women) and the recurrence rate is 0.2%, achieving the goal of an ideal hernia surgery.
The incisions of traditional hernia surgery, natural tissue suturing method, 2D (Bassini) and 3D (Shouldice) are large (6 to 12 cm for male and 5 to 8 cm for female). Vertical incision of subcutaneous tissue and fascia is more damaging to tissue. The postoperative scarring reaction period is longer, which will form long lumps in the wound, and postoperative pain may be higher; the lumps may last for three months to six months and disappear. In the minimally invasive hernia surgery, a 2-3 cm opening is cut in the skin, and then the subcutaneous tissue and fascia are opened with the minimally invasive device and not broken. Therefore, the postoperative tissue swelling and pain are low, less postoperative pain, fast recovery, and smaller scar. It does not form a temporary lump of tissue. Even if a lump forms, it will only form at the surgical incision and will not appear at the upper part of the whole groin, and the speed of disappearance will be faster.