Chapter 7 **Worst Case Scenarios! Complications Related to Hernial Disease 93**

Ahmed Alwahab, Abdulrahman AlAwadhi, Asmaa Abd Alwahab Nugud and Shomous Abd Elwahab Nugud

Preface

Hernia is one of the most ancient surgical problems affecting the mankind. Since the earliest time, various operative and nonoperative modes of treatment for the correction of hernias were introduced and practiced by surgeons. There were various strange surgical operative approaches in practice ranging from excision of the testicles to various noninterventional methods like bleeding the patients and keeping them sedated so as to reduce the obstructed hernias. A number of eminent surgeons of their time tried different strategies for the careful management of hernia. The hernia surgery has passed through a long phase of evolution from the very basic repair by Dr. Edoardo Bassini (1844–1924), who was an Italian surgeon. He presented his technique based purely on the anatomy of the inguinal region and suggest‐ ed a repair procedure by using a suture repair to strengthen the posterior wall of inguinal canal. Dr. Edward Earle Shouldice (1890–1965) introduced the concept of reinforcing the in‐ guinal canal by applying the mesh to repair inguinal hernias. There were many complica‐ tions associated with these traditional procedures for the repair of inguinal and other hernias of which the most dreaded and common complication was the recurrence of the her‐ nia. The surgeons were in a continuous struggle to find an optimal procedure that will offer the best possible surgical procedure to the hernia patients. In 1987, Dr. Irving Lichtenstein reported the consequences of 6321 patients showing a substantially low rate of recurrence after surgery with Marlex (polypropylene) prosthetic material. His strategy bearing his name was termed "tensionless" repair, and after some time, this has turned into a mainstay of hernia repair. The tensionless repair continued and even today is practiced all over the world. The introduction of laparoscopic repair of hernia repair has changed the outlook of hernia patients globally. The current laparoscopic technique involves applying the mesh ei‐ ther through a totally extra-peritoneal approach or through a trans-peritoneal approach. This book gives a very deep insight into the rapidly changing field of hernia surgery. The eminent surgeons involved in the field have contributed their respective experiences regard‐ ing the most recent patterns and specialized adjustments for both normal and complex her‐ nias. The readers will certainly gain a lot of knowledge regarding the basic anatomical concepts and the various advancements in the different techniques offered for the correction of different hernias. Positive critical observations and suggestions will be highly appreciated.

**Dr. Arshad M. Malik**

College of Medicine Qassim University Kingdom of Saudi Arabia

Associate Professor of Surgery
