Dissertation committee:
Πουλάκου-Ρεμπελάκου Ε., Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Ζωγράφος Γ., Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Μενενάκος Ε., Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Βάος Γ., Ομότιμος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ζάβρας Ν., Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Αλαμανής Χρ., Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Χρυσοφός Μ., Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Summary:
The General Part of this dissertation includes a comprehensive presentation of the evolution of
the treatment of abdominal wall hernias over time. The recording of reports from antiquity (Ebers
papyrus, “Hippocratic Collection”) proves that prehistoric man suffered from hernia.
The first human attempts to treat hernia were conservative techniques, reduction by manipulation
(taxis), application of poultices and dressings, causing burns in the groin. For the seriously ill
people, herniotomy was already practiced in India during the Brahman era and by the Greeks with
scrotum access. Until the Byzantine period, surgical techniques included the ligation of both the sac
and the spermatic cord and testectomy. In the 3rd century B.C. Byzantine physicians (Paul of
Aegina , Oribasius) introduce new surgical techniques aimed at preserving the testicles. Man always
turned his hope to divine intervention when he was ill, as is characteristically described in the book
"The miracles of Saint Artemious". During the Middle Ages, the Arab surgeons applied the
techniques of Byzantine writers, but most medieval surgeons remained reluctant to perform surgical
methods. Renaissance surgeons consolidated the surgical approach to inguinal hernia repair, as a
result of better anatomical knowledge and the construction of specialized surgical instruments,
strongly disapproving the removal of the testicle . Despite the development in the knowledge of
anatomy, the introduction of anesthesia in 1846 and antisepsis (Lister, 1865), the surgical treatment
of hernia did not show a similar development during the first half of the 19th century. Enduarto
Bassini holds a prominent place in the history of inguinal hernia. He innovated by introducing the
surgical technique (1883), which was the golden rule of hernia for almost a century (three layers
suturing). The era of hernia repair with non-tension techniques is limited to the middle of the 20th
century, first by fissures in the sheath of the rectal fascia and then with the mesh application
(Lichtenstein 1987). Since then a number of prosthetic materials have been applied, without having
yet found the ideal mesh. Laparoscopic techniques have been widely used since the second half of
the 20th century.
The Special Part presents in detail the historical data, as well as anatomical features, therapeutic
techniques of different types of the abdominal wall hernias. These are: inguinal hernia, umbilical
hernia, epigastric hernia, femoral hernia, ventral hernia and uncommon hernias (Spingle, lumbar,
Petit, Amyand, medial hernia, Littre, Richter, Amyand). Scientists have in their quiver a number of
meshes, surgical techniques with or without the use of mesh, and laparoscopic or open techniques.
The cornerstone of all the above techniques is the sufficient knowledge of the anatomy of each
hernia. Today, both the Lichtenstein technique and laparoscopic techniques (intra-abdominal
preperitoneal or extraperitoneal) are the golden rule in the treatment of hernias. The choice of the
appropriate hernia repair technique remains individual to each patient.
Special mention is given to the historical development of Pediatric Surgery. While, since
Antiquity, records are found for diseases of the pediatric population. The establishment of pediatric
hospitals (19th century), where comprehensive care was offered and the discovery of anesthesia
contributed to the substantial development. Ladd & Gross have played a leading role in establishing
the principles of surgical care for young patients and training the majority of future pediatric
surgery program leaders.
Keywords:
History, Syrgery, Medicine, Hernia
