The Bassini procedure, traditionally used for inguinal hernia repair, has many shortcomings, and the search for the causes of these shortcomings has been an ongoing task for surgeons and has led to a rethinking and reexamination of the anatomy of the anterior abdominal wall, especially the anatomy of the inguinal region. This renewed understanding of the anatomy of the abdominal wall, both morphologically and functionally, has not only helped to enhance the surgeon’s understanding of the development of hernias, but more importantly, has provided guidance and recommendations for the surgeon in the design and performance of surgery, especially in the treatment of certain variants of hernias. The history of hernia repair can be traced back to ancient Egypt, where Dr. Bassini ushered in a new century of modern hernia surgery. Currently, surgical hernia repair techniques include open or laparoscopic techniques and are dominated by the use of synthetic patches. Of course, the evolution of hernia repair is inextricably linked to advances in anatomy and surgical techniques, and in the early 1990s, laparoscopic techniques were introduced and used for minimally invasive hernia repair. Initially, laparoscopy was used for cholecystectomy, followed by other laparoscopic techniques. The earliest laparoscopic hernia surgery was the IPOM (intraperitoneal placement of mesh) technique DD direct intraperitoneal placement of the patch. The technique was initially attractive and was widely recommended by investigators. Surgeons found the procedure simple and easy to learn. However, the follow-up results were not encouraging: the procedure had a high complication and recurrence rate. After an initial follow-up of 41 months, the recurrence rate in the lumpectomy IPOM technique group was 41%, compared to 15% in the control group with a conventional anterior approach [ 1 ]. The subsequent emergence of the lumpectomy approach was the transabdominal preperitoneal hernia repair – TAPP ( transabdominal preperitoneal approach). This technique mimics the lumpectomy steps and methods performed in other areas of surgery. The totally extraperitoneal technique, DDTEP (the totally extraperitoneal technique), is a new technique that was developed after the TAPP technique. The procedure does not enter the abdominal cavity to manipulate and separate it, thus avoiding the risk of accidental abdominal organ damage in the short term and having the long-term advantage of reducing the chance of patch and bowel adhesions. Statistics show that inguinal hernias account for approximately 75% of abdominal wall hernias. Epidemiological findings suggest that the lifetime risk of developing an inguinal hernia is 27% for men and 3% for women, thus making inguinal hernia surgery one of the most frequently performed procedures worldwide [ 2 ]. Approximately 800,000 patients are treated with hernia surgery each year in the United States. The advantages and disadvantages of the lumpectomy hernia technique have been summarized based on the results of randomized controlled studies of the majority of open and lumpectomy procedures and are listed below: Advantages: l. Reduced postoperative pain 2. Earlier return to work Disadvantages: l. Increased cost of surgery 2. Longer operative time 3. Longer learning curve 4. Higher recurrence and complications in the early years of the surgeon performing the lumpectomy technique Although open tension-free surgery is still the standard approach, with adequate training of the surgeon, lumpectomy hernia surgery can achieve the same good results as open hernia [ 4 ]. In a five-year follow-up comparison of open surgery and TEP, Eklund et al. found that the incidence of chronic pain was 1.9% in patients undergoing lumpectomy compared to 3.5% in patients undergoing open surgery [ 5 ]. Laparoscopic hernia repair refers to one of the three techniques described below: total extraperitoneal laparoscopic hernia repair (TEP): this surgical technique is described in detail in this section. Transabdominal anterior peritoneoscopic hernia repair (TAPP): this technique uses a standard laparoscopic technique to obtain a pneumoperitoneum and thus operate using the abdominal space. The peritoneum in the inguinal region is first sharply incised and then bluntly dissected, thus exposing the preperitoneal space. The patch is placed and fixed using the same technique as the TEP technique. The final step is to suture the peeled peritoneum and restore it to its normal anatomic position. Intraperitoneal patch internal hernia repair (IPOM): using a laparoscopic technique, a double-layered anti-adhesive patch is placed over the musculopubic foramen area and fixed. The preperitoneal area does not need to be dissected and there is very little dissection. TEP and TAPP techniques The most commonly used lumpectomy hernia procedures are the TEP and TAPP techniques [ 6, 7 ]. Ger et al. were the first to report a lumpectomy hernia repair method in 1990, when a mesh plug was simply placed in the inguinal defect [ 8 ]. The TEP technique involves the creation of a preperitoneal space behind the inguinal canal with the aid of a Veress pneumoperitoneum needle or pneumatic balloon, and the placement of the patch follows the same procedure as the TAPP technique. The procedure for placement of the patch is the same as for the TAPP technique. Comparing the TEP and TAPP techniques, TEP has the advantage of less postoperative pain and fewer complications associated with intraperitoneal manipulation, but TEP requires a higher level of skill and a longer learning curve. Because of its ease of use, many surgeons generally prefer the TAPP technique when performing lumpectomy hernia surgery. This technique is also a direct evolutionary evolution of the IPOM technique. The advent of techniques such as inflatable balloon separation has led to the progressive development and increasing preference of the TEP technique, which is designed to avoid direct access to the abdominal cavity, thus greatly reducing the risk of patch and bowel adhesions. Some physicians prefer the TAPP technique because of the simplicity of the procedure, the clear anatomical view, and the lack of need for special equipment and instruments. TAPP procedures can be performed in any department that has mastered the lumpectomy gallbladder technique. Considerable research has demonstrated the advantages of laparoscopic hernia repair over open surgery in terms of mild postoperative pain and earlier return to work and normal activities. Despite this, many physicians do not perform laparoscopic hernia techniques, based on a number of factors: First, mastering the laparoscopic hernia technique requires complex training compared to the Lichtenstein technique. Most physicians who have not undergone special courses (including qualification and extensive coaching) have difficulty in switching to laparoscopic techniques, so only about 30% of inguinal hernia operations are currently performed using the TAPP or TEP techniques. Second, lumpectomy is more expensive than traditional open surgery due to economic considerations. Of course, both techniques are less expensive than other surgical laparoscopic procedures. This has motivated surgeons to invest more time and effort in mastering this technique. Most surgeons are now gaining considerable experience in lumpectomy gallbladder surgery, enough to perform the TAPP technique. Recurrence rates for both open hernia surgery and lumpectomy hernia surgery are very low, and the results of randomized controlled studies do not differ between the two. Studies suggest that larger patches appear to help reduce the long-term recurrence rate. With experience and technical advances, complications of lumpectomy hernia surgery are very rare. Numerous follow-up studies have found that the complication rates for open and lumpectomy surgery are almost identical. Complications of open surgery are more likely to present as inguinal area hematoma and vulvar edema. The initial implementation of the ventral hernia technique requires the purchase of equipment, thus adding additional costs [ 1 ], but is more beneficial to the patient and society as measured by economics because the patient can return to work more quickly. The advantages of a lumpectomy hernia also include the ability to explore and repair the contralateral inguinal hernia simultaneously and with only a small increase in operative time. As with lumpectomy gallbladder surgery, mastery of lumpectomy hernia surgery requires a learning curve, and mastery of TEP techniques requires a longer learning curve than TAPP. Surgeons who have experience with other lumpectomy procedures are more likely to survive the learning curve and are able to reduce complications during the procedure. Some of the early studies suggested a higher recurrence rate for lumpectomy hernias and questioned the additional cost. Over the past few years, however, there has been increasing evidence that experienced and skilled surgeons performing lumpectomy hernia surgery have a clear advantage. The additional cost of lumpectomy is more than compensated by two advantages: faster recovery to basic health and simultaneous completion of the contralateral inguinal hernia surgery. New techniques and approaches progressively avoid the use of expensive intraoperative instruments (such as dilating balloons and separation devices), thus reducing costs. Some new techniques use single-port techniques and robotics and reduce the number of trocars needed for the operation. These reports suggest that the new techniques are as effective as the established techniques for ventral hernia. However, whether these techniques have achieved significant advantages needs to be confirmed by clinical trials in multiple centers.