Preperitoneal inguinal hernioplasty with ULTRAPRO versus PROLENE mesh

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Preperitoneal inguinal hernioplasty with ULTRAPRO
versus PROLENE mesh

• Chei Mei medical center
• Uen Yih-huei

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Introduction (I)

• 1. PROLENE Hernia System (PHS) has been developed
  to improve the result of hernioplasty . However,
  it is difficult to definitely deploy PHS's
  underlay patch with surgical methods

Onlay patch
Underlay patch
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• 2. Underlay "pocket" graft of modified PHS has
  been developed to facilitate it's deployment (U
  Y-H Am surgeon 2007)

additional patch
PHS
underlay "pocket graft
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• 3.Theorectically, if the underlay graft can be
  fully deployed to cover entire MPO, there is no
  need of onlay patch and connector device

additional patch
PHS
underlay "pocket graft
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Introduction (II)

• 1.The underlay graft has been newly made by
  ULTRAPRO mesh
• 2.ULTRAPRO mesh has been claimed to be not only
  partially absorbable resulting less amount of
  mesh volume but also strong enough to overcome
  the greatest abdominal pressure during coughing

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Aim

• 1.To assess the adequacy of underlay "pocket"
  graft in preperitoneal hernioplasty
• 2.To compare the effectiveness of ULTRAPRO(U)
  mesh versus PROLENE(P) mesh in hernioplasty

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Material and Methods (I)

• 1. From June 1 2005 till Dec 31 2006, totally 81
  patients with unilateral primary inguinal hernia
  undergoing preperitoneal hernioplasty (through
  anterior approach) with underlay "pocket"
  graft(10 cm in diameter), were randomized into
  two groups
• A.PROLENE group(40 Pts) with inner layer of P
  mesh and outer layer of U mesh
• B.ULTRAPRO group(41 Pts) with both inner and
  outer layers of U mesh

PROLENE group
inner layer P mesh
outer layer U mesh
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Material and Methods (II)

• 2.Prophylatic antibiotics Cephazoline I gm
• IV preop
• 3.Regular OPD FU Q6 months ( at least 2 years )

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Surgical methods

• 1.Preperitoneal dissection
• 2.Insertion of the underlay graft into
  pre-peritoneal space
• 3.Deployment of the underlay graft with
  instrumental and digital manipulation
• 4.Fixation of the graft on fascial defect edge

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Table (I) Patient characteristics
Insignificant difference between both groups
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Table (II) Results
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Discussion (I)

• Summary of the results of present study
  1.Underlay "pocket" graft without
• onlay patch or connector device is
• adequate for preperitoneal hernioplasty
• 2.ULTRAPRO mesh is as efficient as
• PROLENE mesh in inguinal hernioplasty

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Discussion (II)

• Problems encountered during anterior
  preperitoneal hernioplasty
• A .Adequate preperitoneal dissection
• B .Full deployment of mesh prosthesis
• C .Immobilization of mesh prosthesis
• D .Proper mesh strength
• E .Minimal mesh volume ( All but the
  first one can be successfully settled
• by ULTRAPRO underlay "pocket" graft ! )

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Further studies

• The role of ULTRAPRO underlay pocket graft in
  recurrent inguinal herniashould be further
  delineated
• Comparison of the operative results and quality
  of life between underlay pocket graft and
  laparoscopic hernioplasty using ULTRAPRO mesh

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Conclusion

• The ULTRAPRO underlay "pocket" graft used in this
  study is an useful alternative
• for preperitoneal inguinal hernioplasty with
  favorable clinical results and no increase amount
  of foreign body.

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Thanks for your attention!!