The Evolution of Inguinal Hernia Repair from the Langenbeck–Gerdy Subcutaneous Technique to Durham and Subsequent Dissection Procedures: A Historical Review

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Dear Colleagues! You have done a great deal of archival research. After reading your article, I have several suggestions, comments, and questions.

1) I propose changing:

a) the title of the article to; "Evolution of inguinal hernia repair from Langenbeck-Gerdy subcutaneous to Durham and subsequent dissection procedures: a historical review"

b) "Keywords": inguinal hernia, repair, surgeries, subcutaneous, dissection, history, antiseptic".

2) In the "Abstract": 

a) there is the abbreviation "Lucas-Ch" without its previous expansion

b) the Wood operation is designated as 1860, and in Table 1 - 1858.

3) On page 2 in line 2 there is a typo: "Champagne"

4) Why is the word "inguinal" not among the "Keywords" in "Materials and Methods"? Perhaps this limited the results of your search.

5) In the first line of section 3.1, it would be advisable to indicate, as in Table 1, the year the Langenbeck operation was performed - 1808.

6) Why are there no original works in the References Langenbeck, only the 2024  year article about him? Thanks for your cooperation.

Author Response

1. The reviewer´s suggestion is accepted and the title and the keywords are modified.
2. The reviewer´s suggestion is acepted, and the name and its abbreviation are modified. The tex is corrected accordingly: Lucas-Championniere
3. or 2b. The tecnique was initially published in 1858 and later revised in 1860. The Table is correct. To avoid any doubt, the reviser´s warning is accepted, and the year is included in the text to mach: 1858-1860.
4. 3. On page 2, line 2: the error has been identified and corrected. Thank yor for the warning.
5. 4. Ok. The word "inguinal" was indeed used in the search. The error has been verified and corrected. Thank you for the warning: "inguinal hernia surgery"
6. 5. The author´s suggestion is accepted, and the line is completed with the year of the operation. Thanks to the reviewer for improving the clarity of the manuscript. Good point for readers: (1808).
7. The reviewer´s note is correct. Older citations are omitted in favor of a current one that includes all the author´s studies and a comprehensive review of his anatomical and surgical contributions. We believe readers feel more confident with current citations than with older works that are difficult to read and find. Thack you. so much for your positive feedback and for helping us improve our manuscript.

Reviewer 2 Report

Comments and Suggestions for Authors

Please see attached file

Comments for author File: Comments.pdf

Author Response

1. The introduction consists of two large paragraphs and 241 words. We believe it focuses on the objective of the work without repeating the content that is developed later.
2. 2. The reviewer´s suggestion is accepted and the type of hernia to by Langenbeck is included: oblique or external, direct or internal, and femoral hernia. 
3. The study focuses on a very specific period, where the events take place in Europe. The first American surgeons came to train in Europe (Edinburgh, London, Paris, Vienna, etc.) and upon returning, they developed their expertise in their country of origin, but they were already later than Bassini (as in the case of Halsted). It was not the purpose or objective of this study to address other continents, such as Africa, China or India.
4. The reviewer´s suggestion is accepted and the citations of the works are added to the figures and the Table 1, where the original techniques and the provided photo are found.
5. In the historical record that has been passed down to us, as I indicate in the introduction, it is stated that Lucas-Ch was the first surgeon to open the oblique aponeurosis and perform an open dissection of the spinal canal. We have verified and demostrated in this study that this was not the case. The opening was first performed in England, the country where antisepsis also originated. Official history has also attempted to downplay Marcy´s contribution, even though he was already closing the inner ring in the 1870s. Trained in England, he was ahead of many French and Germans in his operations, who are frequently cited. Another detail I want to emphasize is the mention of the German Riesel, an unknown figure in the major reference text (Nyhus, Bendavid, Chevrel, Stoppa, etc.) Therefore, we believe this work will be of great interest to readers.
6. I´m not sure I understand the reviewer´s question. Langenbeck never knew anesthesia, so his contribution as the father of the specialty should be remembered. He used drinks and infusions. The rest were already using chloroform for their operations, although those were years of experimentation, as was the use of antisepsis, which was rudimentary during those years and was only perfected by the end of the 19th century.
7. Excuse me. Again, I´m not sure I understand what the reviewer is asking. They are not comparable from the outset, as each of them, throughout the history of radical hernia surgery, was shaped by their time and by the introduction of anesthesia and antisepsis in their respective countries and hospitals. Wood was the greatest specialist in experience and dedication, but he never dared to open the external oblique muscle and resorted to sutures of the inguinal canal that were difficult for his colleagues to perform. Marcy, Steel, Macewen, Czerny, and many others only closed the inguinal ring, a completely insufficient measure to prevent recurrence. Only after the arrival of Bassini and Halsted did hernia surgery begin toi be fully integrated, with an anatomical basis (for each planbe) for the entire inguinal canal. Humbly, I don´t believe that adding reflections from another era would contribute anything to the study. Its focus and objective are clear and precise. It would only increase the legth of the text and introduce dubious or personal opinions. Thank you so much for your thoughts and contributions. Thank you for your time.

Reviewer 3 Report

Comments and Suggestions for Authors

The manuscript describes the history of radical hernia repair from 1808 to 1888

- The introduction is very short, must improve it

- Results. “12 cases of the three main types of hernia using”, includes more information os short description about these three main types of hernia

- Table 1, why the information was from European Countries and USA, no information from Latin-American and Africa?

- If figures were taken from bibliography, must cite it

- Try to compare the historical and actual update on the radical cure of hernia

- Mentioned if was used drugs in hernia repair

- Include short information about the advantages or disadvantages to used procedures to hernia repair 120 years ago

Author Response

1- The introduction is very short, must improve it

Response 1: The introduction consists of two large paragraphs and 241 words. We believe it focuses on the objective of the work without repeating the content that is developed later.

2- Results. “12 cases of the three main types of hernia using”, includes more information os short description about these three main types of hernia

Response 2: The reviewer's suggestion is accepted and the type of hernia referred to by Langenbeck is included: oblique or external hernia, direct or internal hernia, and femoral hernia.

3- Table 1, why the information was from European Countries and USA, no information from Latin-American and Africa?

Response 3: The study focuses on a very specific period, where the events take place in Europe. The first American surgeons came to train in Europe (Edinburgh, London, Paris, Vienna, etc.) and upon returning, they developed their expertise in their country of origin, but they were already later than Bassini (as in the case of Halsted). It was not the purpose or objective of this study to address other continents, such as Africa, China or India.

4- If figures were taken from bibliography, must cite it

Response 4: The reviewer's suggestion is accepted and the citations of the works are added to the figure and the table 1, where the original techniques and the provided photo are found. [-]…

5- Try to compare the historical and actual update on the radical cure of hernia

Response 5: In the historical record that has been passed down to us, as I indicate in the introduction, it is stated that Lucas-Ch. was the first surgeon to open the oblique aponeurosis and perform an open dissection of the spinal canal. We have verified and demonstrated in this study that this was not the case. The opening was first performed in England, the country where antisepsis also originated. Official history has also attempted to downplay Marcy's contribution, even though he was already closing the inner ring in the 1970s. Trained in England, he was ahead of many French and Germans in his operations, who are frequently cited. Another detail I want to emphasize is the mention of the German Riesel, an unknown figure in the major reference texts (Nyhus, Bendavid, Chevrel, Stoppa, etc.). Therefore, we believe this work will be of great interest to readers.

6- Mentioned if was used drugs in hernia repair.

Response 6: I'm not sure I understand the reviewer's question. Langenbeck never knew anesthesia, so his contribution as the father of the specialty should be remembered. He used drinks and infusions. The rest were already using chloroform for their operations, although those were years of experimentation, as was the use of antisepsis, which was rudimentary during those years and was only perfected by the end of the 19th century.

7- Include short information about the advantages or disadvantages to used procedures to hernia repair 120 years ago

Response 7: Excuse me. Again, I'm not sure I understand what the reviewer is asking. They are not comparable from the outset, as each of them, throughout the history of radical hernia surgery, was shaped by their time and by the introduction of anesthesia and antisepsis in their respective countries and hospitals. Wood was the greatest specialist in experience and dedication, but he never dared to open the external oblique muscle and resorted to sutures of the inguinal canal that were difficult for his colleagues to perform. Marcy, Steel, Czerny, Macewen, and many others only closed the inguinal ring, a completely insufficient measure to prevent recurrence. Only after the arrival of Bassini and Halsted did hernia surgery begin to be fully integrated, with an anatomical basis for the entire inguinal canal. Humbly, I don't believe that adding reflections from another era would contribute anything to the study. Its focus and objective are clear and precise. It would only increase the length of the text and introduce dubious or personal opinions.

Thank you for your time. Thank you so much for your thoughts and contributions.

Reviewer 4 Report

Comments and Suggestions for Authors

The manuscript entitled "Historical update on the radical cure of hernia, from Lister to Bassini: When is subcutaneous surgery abandoned and dissection surgery initiated?" represents a valuable contribution to the field, providing an interesting historical perspective on the development of hernia repair techniques. The work is generally well-written and informative; however, several issues should be addressed to improve clarity, scientific rigor, and adherence to journal standards:

1. Systematic review clarification: It is unclear whether this manuscript is intended as a systematic review. If so, the methodology should be clearly described, relevant inclusion/exclusion criteria detailed, and a PRISMA flow diagram included. Adjustments and corrections in line with systematic review standards are necessary.

2. Affiliations: Author affiliations are not presented correctly. Please remove terms such as “head” from the affiliations and ensure all institutional information follows the journal’s formatting guidelines.

3. Abstract – Background: The current background statement reads: “The history of radical hernia repair was a period of great activity and may have been influenced by factors of the time. Subcutaneous surgery was modified after the introduction of antisepsis, leading to dissection surgery.” These sentences require careful revision for clarity, precision, and scientific accuracy. Consider specifying the historical context and surgical developments more explicitly.

4. Abstract – Conclusion: The statement “There are errors in the references to the period of radical hernia repair” is unclear. Please provide specific explanations of these errors and correct the conclusions accordingly.

5. Introduction: The sentence “The history of radical hernia repair involves numerous surgeons and every country in the world” is overly broad and imprecise. Please rewrite with a more scientifically accurate and nuanced statement.

6. Tables: In Table 1, some lines appear bold while others do not. This may indicate formatting inconsistencies; please check and correct technical issues.

7. References: The reference list requires careful revision to comply with the journal’s instructions for authors, including proper formatting, completeness, and accuracy.

8. Language and style: The manuscript requires extensive editing for English language, grammar, and overall readability to meet publication standards.

Comments on the Quality of English Language

The manuscript requires extensive editing for English language, grammar, and overall readability to meet publication standards.

Author Response

1. Systematic review clarification: It is unclear whether this manuscript is intended as a systematic review. If so, the methodology should be clearly described, relevant inclusion/exclusion criteria detailed, and a PRISMA flow diagram included. Adjustments and corrections in line with systematic review standards are necessary.

Response: The work presented is NOT a systematic review applying these criteria. The study is a simple historical review. It does not generate data nor does it allow for the use of flowcharts. In fact, in many journals, this article category never includes a method section 8Annals, WJS, etc.).

2. Affiliations: Author affiliations are not presented correctly. Please remove terms such as “head” from the affiliations and ensure all institutional information follows the journal’s formatting guidelines.

Response: The reviewer's suggestion is accepted and the word "Head" is removed. It is changed to "Chief".

3. Abstract – Background: The current background statement reads: “The history of radical hernia repair was a period of great activity and may have been influenced by factors of the time. Subcutaneous surgery was modified after the introduction of antisepsis, leading to dissection surgery.” These sentences require careful revision for clarity, precision, and scientific accuracy. Consider specifying the historical context and surgical developments more explicitly.

Response: The reviewer's suggestion is accepted and the introduction of the abstract is modified, in an attempt to clarify the initial sentence: The history of radical hernia repair was a period of intense surgical activity, influenced by factors of the time such as social development, hygiene, anesthesia, and antisepsis. Subcutaneous surgery, the initial option designed to avoid infections and peritonitis, was modified after the introduction of antisepsis, eventually leading to dissection surgery.

4. Abstract – Conclusion: The statement “There are errors in the references to the period of radical hernia repair” is unclear. Please provide specific explanations of these errors and correct the conclusions accordingly.

Response: We share the reviewer's view that the first sentence of the conclusions is not very effective; it is not a conclusion in itself and should be removed. Following the reviewer's advice, it is deleted. This improves the scientific rigor for the reader and avoids the problems with references that were avoided in 19th-century theses.

5. Introduction: The sentence “The history of radical hernia repair involves numerous surgeons and every country in the world” is overly broad and imprecise. Please rewrite with a more scientifically accurate and nuanced statement.

Response: At the reviewer's suggestion, the introduction sentence has been modified. We agree with the reviewer that it was somewhat confusing. It has been changed to a direct, clear, and scientific sentence…. The search for a radical repair for inguinal hernias was a universal historical movement.

6. Tables: In Table 1, some lines appear bold while others do not. This may indicate formatting inconsistencies; please check and correct technical issues.

Response: Following the reviewer's instructions, Table 1 is reviewed and the formatting is checked. There are no bold letters. Some repeated parentheses are removed: ((-), (-)).

7. References: The reference list requires careful revision to comply with the journal’s instructions for authors, including proper formatting, completeness, and accuracy.

Response: The references section is reviewed again and verified according to the journal's guidelines.

8. Language and style: The manuscript requires extensive editing for English language, grammar, and overall readability to meet publication standards.

Response: The reviewer's suggestion is accepted and the manuscript is reviewed by the Department of Languages ​​at our University.

 

Round 2

Reviewer 4 Report

Comments and Suggestions for Authors

Authors made improvements to the manuscript. Table 1 still has formatting issues.

No need to write "chief" or "head" or "director" or any other function in the affiliation, it is not according to scientific standards of affiliation writing. 

Comments on the Quality of English Language

The manuscript requires editing for English language, grammar, and overall readability to meet publication standards.