Advantages of the tension-free method in the treatment of inguinal hernias

Preponske kile su bolest stara vjerojatno koliko i samo čovječanstvo. Njihovo liječenje bilo je izazov brojnim liječnicima kroz povijest. Danas ih više ne smatramo bolešću koja ugrožava život, ali i dalje su česte u populaciji. Većina oboljelih su muškarci koji zbog embrionalnog razvoja imaju predispoziciju za nastanak kile. Operacije kila su danas najizvođeniji zahvati u općoj kirurgiji. Tijekom povijesti došlo je do napretka u kirurgiji hernija. Najznačajniji napredak dogodio se krajem 19. stoljeća, kada je Eduardo Bassini opisao i primjenio metodu rekonstrukcije stijenke ingvinalnog kanala troslojnim šivanjem fascija i mišića kako bi zatvorio kilni defekt. Takav način rekonstrukcije rezultirao je znatnom napetošću među tkivima i čestom pojavom recidiva kao posljedicom. Idući značajan napredak dogodio se uvođenjem protetskih materijala u rekonstrukciju kilnog defekta. Pionirom metode bez napetosti smatra se Irving Lichtenstein koji je upotrijebio polipropilensku mrežicu da bi premostio defekt u stijenci ingvinalnog kanala. Korištenjem mrežice uklonio je napetost među tkivima (tension-free repair) i značajno smanjio stopu recidiva. Posljednji značajni napredak dogodio se uvođenjem laparoskopske tehnike u kirurgiju, čime je omogućeno izvođenje rekonstrukcije tim pristuopom. Idealna metoda trebala bi imati nisku stopu recidiva uz minimalne komplikacije i trebala bi biti jednostavna i jeftina. Pacijentu bi trebala uzrokovati što manje tegoba i omogućiti mu što brži oporavak. Metoda bez napetosti pokazala se kao najbolja od danas dostupnih metoda. U odnosu na metode kojima se kilni defekt zatvara slojevima tkiva, ima znatno niže stope recidiva, kraće vrijeme trajanja zahvata, manju postoperativnu bol, kraće vrijeme boravka pacijenta u bolnici, te je u konačnici isplativija. U odnosu na metode s laparoskopskim pristupom postižu se isti rezultati u vidu stope recidiva, ali bez korištenja opće anestezije i skupe opreme, uz kraće vrijeme trajanja zahvata i manje intraoperativnih komplikacija, te brže svladavanje kirurške tehnike i niže bolničke troškove. Zbog navedenih prednosti, metoda bez napetosti se danas smatra standardnom metodom u liječenju primarnih kila.Inguinal hernia most probably has been a disease ever since mankind existed. Their treatment was a challenge to many doctors throughout history. Today they are no longer considered life-threatening disease, but they are still frequent in the population. Most patients are men who, because of embryogenesis, have a predisposition for development of hernia. Hernia repair is the most common procedure performed in general surgery. Hernia repair has made progress throughout the history. The most significant improvement occurred in the late 19th century, when Eduardo Bassini described and applied his technique of reinforcing the posterior wall of the inguinal canal by triple stitching fascia and muscle tissues. His way of reconstruction resulted in a considerable tension between tissues and frequent recurrence as a result. The next breakthrough was the introduction of prosthetic materials in the reconstruction of the inguinal canal. Irving Lichtenstein is considered to be a pioneer of the tension-free repair by using prosthetic mesh. He used prosthetic material to bridge the gap in the wall of the inguinal canal. That removed a significant amount of tension between the tissues and reduced the recurrence rate. The last significant development was the introduction of laparoscopic techniques in surgery, which allows laparoscopic hernia repair. The ideal hernia repair technique should have a low recurrence rate with minimal complications and should be simple and inexpensive to perform. It should cause low discomfort to the patients and allow them a quick recovery. Tension-free repair proved to be the best choice of the currently available techniques. Compared with the tissue methods there are significantly lower recurrence rates, shorter duration of the surgical procedure, lower postoperative pain, shorter hospital stay and it is more cost effective. Compared to laparoscopic approach, in terms of recurrence rates there are similar results, but without using general anesthesia and expensive equipment, with a shorter duration of surgical procedure and fewer intraoperative complications, also the surgical technique is easier to learn and hospital costs are lower. Because of these advantages, tension-free repair is now considered to be a standard method of treatment for primary inguinal hernias