History of the Clinic and Hernia Repair
Until the advent of laparoscopic surgery and the interest in laparoscopic repair of groin hernia, 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 the United States.

Prior to the advent of the key hole approach which led to a renewed world wide 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 unacceptably 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.

Dr Peter Catts and Dr Michael Aroney had acquired a large experience using a mesh repair for the treatment of recurrent inguinal hernia. Using an open groin incision, the preperitoneal space behind the abdominal wall muscles was exposed and a large sheet of mesh inserted to prevent a further recurrence of the hernia. 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 perform various procedures for groin hernia repair based on surgical experience, patient preference and specific indications for individual patients. The unique aspect about The Sydney Hernia Clinic is that all of the procedures are subject to strict audit with a comprehensive study protocol.