Hernia Across the Spectrum: From Basic Science to Surgical Innovation :A Comprehensive Literature Review

Hernia is defined as the abnormal protrusion of a viscus or part of a viscus through a defect or weakness in the wall that normally contains it. It is one of the most common conditions encountered in general surgical practice, with inguinal hernias accounting for approximately 75% of all abdominal wall hernias. The lifetime risk of developing a groin hernia is estimated to be around 27% in men and 3% in women (Harrison’s Principles of Internal Medicine, 21st ed.; European Hernia Society Guidelines).

From a historical perspective, hernia management has evolved significantly. Early surgical approaches, such as the Bassini repair in the late 19th century, focused on anatomical reconstruction using native tissues under tension. However, high recurrence rates led to the development of tension-free techniques, most notably the Lichtenstein repair, which introduced prosthetic mesh to reinforce the abdominal wall. This marked a paradigm shift in hernia surgery, reducing recurrence rates and improving patient outcomes (Schwartz’s Principles of Surgery, 11th ed.).

The pathogenesis of hernia is multifactorial, involving both mechanical and biological factors. Increased intra-abdominal pressure—due to chronic cough, constipation, heavy lifting, or pregnancy—acts on anatomically weak areas of the abdominal wall. Concurrently, intrinsic abnormalities in connective tissue, particularly alterations in collagen metabolism (decreased type I to type III collagen ratio), contribute to reduced tensile strength and predispose individuals to hernia formation. Recent research conceptualizes hernia as a disorder of connective tissue and biomechanical failure rather than merely a structural defect.

Clinically, hernias present with a wide spectrum ranging from asymptomatic reducible swellings to life-threatening complications such as incarceration and strangulation. Early diagnosis and timely intervention are crucial to prevent complications, particularly in high-risk hernias such as femoral hernias.

In recent decades, rapid advancements in surgical technology have transformed hernia management. Minimally invasive approaches, including laparoscopic techniques such as transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) repairs, offer reduced postoperative pain and faster recovery. Furthermore, robotic-assisted surgery and innovations in mesh biomaterials have introduced new dimensions in precision and patient-specific treatment.

Thus, hernia represents not only a common surgical entity but also a dynamic field integrating anatomy, biomechanics, material science, and advanced surgical techniques. This review aims to provide a comprehensive overview of hernia across the spectrum—from fundamental biological mechanisms to cutting-edge surgical innovations.