Anterior preperitoneal inguinal hernioplasty

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Anterior pre-peritoneal inguinal hernioplasty
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• Yih-Huei Uen, MDDivision of General Surgery,
  Department of Surgery, Chi Mei Foundation Medical
  Center, Tainan, Taiwan, ROC.

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Design(I)

• Modified device /technique of PHS
• An improved method for deploying the
  polypropylene underlay patch of the PROLEN Hernia
  System
• American Surgeon 2007 May, Yih-Huei Uen
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Fig. 1 The procedures of development of a
modified device of PHS.
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Fig. 2 The procedures of intra-pocket
manipulation
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Table 1. Results
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Comparative Laparoscopic Evaluation of the
Original versus Modified Design of PROLENE
Hernia System in A Porcine-groin Hernia-Repair
Model
Study(II)
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Material and Method

• 30 uncastracted male pig (average BW 24Kg)
• Unilateral anterior inguinal hernioplasty
• Group
• Original PHS(n10)
• Modified PHS with onlay fixation (n10)
• Modified PHS without onlay fixation (n10)

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Handassisted laparoscopic stress-loading test
using dynamometer
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Result (I) The laparoscopy of the
preperitoneally positioned mesh prosthesis
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Result (II) Comparsion of the results of
stress-loading test
23.99 0.89
Bursting strength
10.57 0.46
10.20 1.11
lb
Plt0.01 Group2 vs Group1 and 3 Pgt0.05 Group1 vs
Group 3
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Discussion ( I ) Special design and unique
technique of Modified PHS

• Harboring a deploying underlay pocket graft
  with a pressure reception perimeter
• Fixating underlay graft to the fascial edge
• Using a narrow angled metal pusher to perform
  intra-pocket manipulation

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Discussion ( II )Potential advantage of
Modified PHS prosthesis

• Full deployment of underlay graft against the
  inner surface of the inguinal floor to cover
  entire MPO (Pascals principle)
• Secure obliteration of fascial defect
• Increased stability of devices
• Self assessment of the adequacy of deployment

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Discussion ( III )

• The fixation stitches of onlay patch
  traditionally used in Original PHS can be
  substituted by those of fascial edge in
  Modifieddevice if it is strong enough.
• Can post-operative pain be decreased?

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Discussion ( IV )

• Hand-assisted laparoscopic stress-loading test
  with dynamometer
• Firstly used in assessment of the stability of
  hernia repair prothesis
• An useful tool good exposure, mimic nature
  hernia protrusion, easy manipulation and high
  accuracy

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Conclusion

• Groin hernia repair with Modified PHS device/
  technique is a simple and effective way to
  achieve full deployment of underlay graft along
  pelvic anatomy with increased stability.

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Design(II)

• Underlay pocket graft ( enough! )
• Type I PROLENE mesh
• Type II ULTRAPRO (partially absorbable) mesh

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• Underlay pocket graft with ULTRAPRO (partially
  absorbable) mesh

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Study(III)

• Randomized comparison of the clinical result of
  pre-peritoneal hernioplasty with PROLENE vs
  ULTRAPRO mesh underlay pocket graft

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Table 1. Results
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Discussion

• Although long-term follow-up is needed, the early
  result of pre-peritoneal hernioplasty using
  ULTRAPRO mesh is as efficient as PROLENE
  analogue.

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Summary

• Underlay pocket graft, either along use or
  combined in PHS device, can facilitate the result
  of pre-peritoneal hernioplasty. Its role in
  inguinal hernioplasty will be high- lightened by
  the usage of ULTRAPRO mesh.

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Reference

• 1. Gilbert AI, Graham MF, Voigt WJ. A bilayer
  patch device for inguinal hernia repair. Hernia
  19993161-166.
• 2. Uen YH. Comparison laparoscopic evaluation of
  the PROLENE hernia system and the Perfix
  plug-and-patch device in a porcine groin hernia
  repair model. Journal of Laparoscopic Advanced
  Surgical Technique 200414(6)363-373.
• 3. Murphy JW. Use of the prolene hernia system
  for inguinal hernia repair retrospective,
  comparative time analysis versus other inguinal
  hernia repair systems. American Surgeon
  200167(10)919-923.
• 4. Uen YH. An improved method for deploying the
  polypropylene underlay patch of the PROLEN Hernia
  System American surgeon 2007 May

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Thanks for your attention !
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