Today's controversies in hernia surgery.

For more than a century, since the introduction of modern hernia repair by Basinni, technical aspects of hernia surgery have been surrounded by controversies. The purpose of this article is to examine these controversies with special attention to (a) mechanical versus degenerative nature of hernias, (b) traditional tissue approximation repair (tension repair) versus tension-free mesh repair, (c) patch or plug repair, and (d) open versus laparoscopic approach. It is concluded that the concept of open tension-free hernioplasty, utilizing a patch of appropriate synthetic material through an anterior approach, is a potential resolution of the controversies that have surrounded the subject of hernia surgery for more than a century.