The hernia community has lost a prolific author and practitioner with the recent passing of Hugh “Brendan” Devlin. His first edition of this book, which appeared in 1988, displayed broad scope, clarity and an engaging style. This new edition, with coauthor Andrew Kingsnorth, has the clear prose of its predecessor and larger type for readability. The volume is bound sturdily, with an attractive red hard cover.
The book is organized logically, starting with scientific principles, followed by descriptions of clinical conditions and specific operations. It is targetted to residents and qualified general surgeons interested in abdominal wall hernias. Since most general surgeons repair hernias, this book has broad appeal.
Herniology has exploded since 1988, with new appreciation of anatomy, perioperative care, outcome measures, economics, laparoscopy and the acceptance of prosthetic mesh. The current edition has addressed these issues. New chapters are devoted to laparoscopic groin hernia repair and outcomes of inguinal hernia repair. Coverage of logistics and economics, has increased, and the section on anatomy contains added material on the space of Bogros and views from a laparoscopic perspective. Over 300 new references have been added, for a total of 1010 citations listed alphabetically at the end of the book.
In the preface to the first edition, Devlin stated that he did not want to write an exhaustive text: this edition of Management of Abdominal Hernias is by no means exhaustive. The book omits or covers superficially some important areas of clinical care, such as how to manage hernias during pregnancy, hernia repair concomitant with other operations, flank incisional hernias, groin hernia repair in women, antibiotic prophylaxis, postoperative analgesia and management of multiply recurrent groin hernias. In many parts, especially those covering logistics and economics, a United Kingdom perspective makes the discussion less relevant to North American readers.
The early chapters on the history of hernia repair, anatomy and etiology are the most valuable. Explanatory line drawings complement textual descriptions of the relevant anatomy; colour photographs are not used except for the section on laparoscopic procedures. Coverage of the indications and specific techniques of hernia repair must be criticized. The advocacy of some surgical techniques and methods of repair over others is variously arbitrary, confusing or unexplained. For example, the Shouldice repair is recommended for first-time groin recurrences on page 158, but on page 197, the use of extraperitoneal prosthetic mesh is advocated for that indication. Important methods of primary groin and incisional hernia repairs have been omitted. Descriptions of some operative techniques are confusing, such as the Cooper’s ligament transition stitch. Unsupported recommendations include the advocacy of drains, even in umbilical hernia repairs, with no mention of the increased infection rates associated with their use. Although the book generally is well edited, typographic errors can be found.
Despite its limitations, this text should be in medical libraries. It is rich in useful information. Devlin has achieved his goal of writing a “neat practical book” about hernias.