With the advent of the widespread use of laparoscopic surgery in Australian in 1990, there soon developed an interest in the laparoscopic repair of groin hernia. At that time (1990) there were only two well-known clinics in the world specialising in the treatment of hernia. These clinics were the Shouldice Centre in Canada and the Lichtenstein Centre in USA.
Prior to the advent of the keyhole approach which led to a renewed worldwide interest in hernia repair, most surgeons were performing a standard Bassini hernia repair. This involved stitching of tissues under tension. When the results of this procedure were critically examined it was found that there was an unacceptable high recurrence rate. The Bassini hernia repair was effective and efficient in 80% of patients but there were many patients troubled by recurrence of hernia and pain after surgery. There was a tendency to treat hernia repair as a relatively minor operation. Because the procedure was so well established in the minds of surgeons and, because of the absence of controversy about the established method of repair, there was little pressure for change.
The complacency about hernia repair disappeared when controversy erupted around the introduction of laparoscopic hernia repair in the early 1990s. Extensive media exposure both promotional and adverse, raised awareness amongst surgeons of the need to review the techniques used for inguinal hernia repair.
Surgeons at Holroyd Private Hospital established The Sydney Hernia Clinic to understand better the use of mesh in the repair of hernia based on the experience of some surgeons who had acquired extensive experience using mesh to repair difficult and complicate recurrent inguinal hernias. The importance of placing mesh behind the muscles damaged by the groin hernia rather than using an overlay of mesh on the muscles, had been recognised as being very important in treating these most difficult hernias. It became apparent that the results of this repair were more satisfactory than the results of standard procedures. Traditionally recurrent hernias were repaired by a further attempt at the Bassini procedure thus leading to further disruption of the groin tissues and a frustratingly high percentage of "re-recurrences".
The extended use of laparoscopy for general surgery led to recognition of the fact that it was feasible to insert a sheet of mesh into the preperitoneal space by laparoscopy.
It thus became possible to perform a procedure traditionally reserved for recurrent hernias for the treatment of all groin hernias. The procedure was also possible without the need for an extensive operative dissection of the abdominal muscles that was used previously.
At The Sydney Hernia Clinic surgeons now perform most hernia repairs laparoscopically with the use of polypropylene mesh. This modern practice is based on extensive experience with these operations and the result of outcome studies and patient preference.