Bassini and his injury
Edoardo Bassini was an Italian surgeon, and as the fate would have it he devoted his life for a perfect hernia repair. Born in 1844, he graduated in basic medicine at a young age of 22. Nationalism pushed him to the war-zone. In 1867 an enemy bayonet pierced his right groin, he was back in his medical school to get it repaired.
Unfortunately, the bayonet pierced upto his intestine. This not only led to a groin infection, but also leaked his excreta for over a year.
Bassini travels wide and far
After a long period of recovery, Bassini was encouraged by his mentor Luigi Porta, to travel wide and meet some famous names in surgery. His travels took him to Theodor Billroth – a father figure from Vienna, and Joseph Lister a proponent of asepsis from London. In 1874, Bassini was back in Pavia, Italy with a lot of surgical insights.
Bassini could never get his focus away from groin, probably due to his own suffering. He dissected many a groins from cadavers, and surgically stitched them over to gain more insight. Till that time it was a neglected area of the body. As Anesthesia was already there, more famous surgeons like Billroth were solving seemingly more complex problems related to stomach and bowel. However, Bassini developed a new insight on how to better repair hernias.
Hernia and its repair
Hernia was never an uncommon occurrence, and we still frequently repair them in surgical operating rooms. Most common types are “inguinal” or groin hernias. A part of the intestine, that should remain in the abdomen, tends to come out of its natural space. It leads to a swelling, seen over the groin, that can be gently reduced and made invisible. But a slight strain or a cough can push it out again, as a lump over the groin. In men, this lump may go all the way down into the scrotum.
A primitive way was to tie up a belt from the outside. Surgeons had also started reducing a hernia, and stitching up the opening from where intestines were drawing out. Most hernias repaired this way would recur.
Bassini’s repair
Bassini developed a technique to repair the entire inguinal canal (or herniorraphy). By 1890 he had repaired about 292 hernias, and only seven of them recurred in four years of follow up. Bassini remained an active surgeon till 1919, when he retired. He lived on till 1924. His achievement is even more impressive if we realize that all subsequent methods of inguinal hernia surgery were in fact variants of Bassini’s concept.
In subsequent years, and till the end of second world war, modifications in Bassini’s technique were performed by William Steward Halsted (1889), Zdzisław Sławiński (1916), and Edward Earl Shouldice (1953). Shouldice introduced polymers like polyester and polypropylene that were used as a surgical mesh. Dr Irving Lichtenstein perfected the mesh repair, and also introduced laparoscopic hernia surgery. Despite all these variations, Bassini’s technique is a fundamental teaching concept in hernia surgery till date.