I often hear that industrial development is now version 4.0, and what other version 4.0 is there for inguinal hernia – also known as small bowel hernia surgery? But looking back at history, the contemporary surgical approach is indeed version 4.0. Let’s start with the picture. In ancient times, humans had limited knowledge of hernia disease, only recognizing that a hernia arises from a rupture somewhere in the abdominal wall. For a long time in ancient Greece until the Middle Ages, the main treatment for inguinal hernias was compression with a hernia belt, and surgery was only considered for those in severe pain. The so-called surgery was also still very primitive, and surgeons in medieval Europe even originated from barbers and tailors. There was no anesthesia, the hernia sac was removed and then the wound was allowed to open naturally, destroying the local tissue through natural scar formation or even by burning with an iron, ultimately by forming a large number of scars to block the hernia; some doctors also cut off the “balls” together with the affected side. It is not terrible, but this is the truth, the barbaric and bloody version 1.0. With the Renaissance, medicine was gradually revived and European medical doctors gradually carried out various anatomical studies and gradually understood the local structure of the inguinal region, and now many anatomical names of the groin are named after those medical doctors. At the same time, the surgery was not as barbaric as in 1.0, the branding iron was not used and the “balls” were preserved. Since inguinal hernia is a local hole in the tissue and there are various anatomical structures around it, the era of repair began. But don’t look at the small area of the groin, there are quite a lot of anatomical structures, and at that time it was not known what ligaments and what tendons should be sewn together better, so many doctors came up with their own patching methods. There were many different opinions, schools of thought, and a melee, with everyone saying they were better, but no one could convince anyone. However, the results of patients after surgery are a disappointing slap in the face of many “masters”, with recurrence rates generally higher than 50%. This is the 2.0 version of inguinal hernia surgery, the era of “messy patching”. But the struggle of anatomists and surgeons did not stop. It was until the 1880s that a suture repair method invented by Dr. Bassini in Italy achieved good results, reducing the recurrence rate from fifty (50%) to fifteen (15%). This was a milestone in the transition from a mostly unsuccessful outcome to a mostly successful one, and after 1900 this procedure became very popular, with some small modifications based on it, but the underlying concept was identical to that of the Bassini repair, which meant that we finally discovered that the underlying cause of inguinal hernias was a weakness in the posterior wall of the inguinal canal –It also means that we have finally found the correct suture repair method. That’s why I call it version 3.0, which has been prevalent for almost 100 years and which we still use today for some specific cases. The core of the procedure in 2.0 and 3.0 is “suture”, but the pain is unavoidable by forcing the two distant tissues together because of the tension, so we classify this type of procedure as a “tension” repair. It is accompanied by a long post-operative recovery period, which is why the doctors would give the patient a sick leave of “six months of reduced work” after the surgery. From the perspective of modern medicine, a 15% recurrence rate is also a very high failure rate. As a “patch” can be made to mend clothes, medical doctors also want to do the same to repair hernias. “patches”. With the patch, the surgeon can preserve the body’s original physiological structure and tissue layers to the maximum extent possible. Patients have less postoperative pain, and non-manual workers can return to their daily work within a week after surgery, and the recurrence rate has been reduced to less than 1%. Since its inception in the 1980s by Dr. Lichtenstein in the United States, it has quickly spread throughout the world, and I call this surgery the 4.0 version of hernia repair. In the last decade or so laparoscopic surgery has also maximized the advantages of tension-free surgery with less trauma, less postoperative pain, and faster recovery. I believe that there will be 5.0 and 6.0 in the future, and the surgery will be more efficient and minimally invasive then.