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Abstract
<p class="first" id="d1124930e43">One hundred years ago, Edoardo Bassini said: "L'ernia
é una malattia meccanica." Before
that, Ambroise Paré (1598) and Joseph-Pierre Desault (1798) asserted the mechanical
nature of strangulation. Beside strangulation, the most serious of all complications
even today, I have studied huge hernias, which are natural complications, and recurrent
hernias, which are the complications of suboptimal repairs. In this article, I consider
the general features and diagnostic and technical consequences of the repair of groin
and incisional hernias. The treatment of strangulating hernias, usually an emergency
operation, has not seen any recent technical progress. Huge and recurrent hernias,
however, usually allow time for adequate surgical preparation. These hernias are also
amenable to modern prosthetic repairs. In prosthetic repairs, large pieces of polyester
mesh are inserted beneath the muscular wall outside the peritoneum. They act as artificial,
nonabsorbable endoabdominal fascia, making the abdominal wall instantly and definitively
pressure tight. The state of hernial surgery has advanced to the point that one must
consider the systematic surgical cure of all diagnosed hernias.
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