Inguinal hernioplasty with the Prolene Hernia System

Most tension-free hernia repair techniques achieve 0.1%–0.4% recurrence rates in patients with primary hernias. Currently, the Lichtenstein technique is considered to be the criterion standard. The Prolene Hernia System (PHS) is a recently introduced hernia-repair device that combines three proven mechanisms of action. We retrospectively reviewed early and late complications in 250 patients who underwent inguinal hernioplasties—125 performed with the Lichtenstein technique and 125 performed with the PHS—from March 1998–October 2002. Patients who underwent Lichtenstein hernia repair had nine complications, and those who underwent PHS surgery had only two; none of the complications were serious. Older male patients who underwent Lichtenstein hernia repair were more likely to have complications (P=0.04). One patient in the Lichtenstein group had a recurrence of his hernia, but there were no recurrences in the PHS group. In conclusion, the results of inguinal hernioplasties performed with the PHS are comparable to those achieved with Lichtenstein hernia repair, the criterion standard technique.     

普理灵疝装置修补老年腹股沟疝40例体会

目的：观察普理灵疝装置(PHS)在老年腹股沟斜疝修补术中的应用效果。方法：使用强生公司PHS修补老年腹股沟疝40例（包括马鞍疝2例），其中有单侧疝36例，双侧疝4例：原发疝29例，复发疝11例。复发疝中1例前手术为单纯平片修补术，10例为传统张力修补术。结果：40例老年腹股沟疝病人修补术后结果满意，短期随访效果良好。结论：普理灵疝装置在腹股沟疝修补术中是有效，安全，方便的。     

普理灵疝装置在日间腹股沟疝无张力修补中的应用

目的 探讨局麻下普理灵疝装置在日间腹股沟疝无张力修补中的应用。方法 1998年2月-2003年2月，采用美国强生公司生产的普理灵疝装置作为疝修补材料，局麻下进行170例腹股沟疝日间无张力疝修补术。结果 手术时间15min-68min，平均35min。留院观察3h-20h(平均8h)，术后患牵拉感和伤口疼痛轻微，均未使用止痛药。无切口感染，无尿潴留，阴囊积液4例。随诊2月-14月，平均8月，无异物感，无复发。结论 局麻下普理灵疝装置在日间腹股沟疝无张力修补术是一种安全、可靠的手术方式。     

普理灵疝装置在腹股沟疝修补术中的应用

目的：探讨普理灵疝装置（PHS）在腹股沟疝修补术中应用的解剖学基础，使用特点以及手术中应注意的问题。方法：对52例使用普理灵疝装置行无张力修补术的腹股沟疝病人进行分析。结果：手术时间为25－70min ,术后需时使用止痛剂者6例，阴囊轻度肿胀者2例，术后无切口感染及血肿发生，平均住院时间为4.5d，随访无复发及腹股沟区明显异物感。结论：此装置能满足修补和加强耻骨肌孔区域的解剖学要求尤适用于巨大疝，复发疝，复合疝和老年疝的修补尤为适用。术中腹膜前间隙内下层片的充分展平，到位，是手术成功的关键。     

普理灵疝装置治疗老年腹股沟疝65例临床分析

目的 探讨普理灵疝装置(prolene hernia system,PHS)在治疗老年腹股沟疝手术中的应用价值及疗效.方法 回顾性分析我院2009年6月至2011年5月收治的应用普理灵疝装置进行疝修补的老年腹股沟疝患者65例临床资料,观察手术时间、术后并发症、术后首次下床时间、住院时间及随访情况.结果 65例患者均治愈出院,手术时间30~95 min,平均53 min;下床活动时间1~3 d,平均1.1 d;住院时间2~7 d,平均3.8 d.除2例出现皮下积液,经穿刺抽液治愈外,其他患者无感染、积液、灼痛、复发等并发症发生.结论 应用普理灵疝装置治疗老年腹股沟疝简单、易行,疗效可靠,值得临床推广.     

Incisional, epigastric and umbilical hernia repair using the Prolene Hernia System: describing a novel technique

The Prolene Hernia System (PHS) is already widely in use in the United Kingdom for inguinal hernias. We describe the novel technique of using the three-in-one design of the PHS (Ethicon Endo-Surgery, Bracknell, UK) for repairing incisional, epigastric and umbilical herniae. This is a three-dimensional device and consists of an onlay patch, a tubular connector and an underlay patch. We recommend a four ‘corner’ suturing of the underlay patch under vision (and then) through the full thickness of abdominal wall layers to ensure a flat underlay mesh. These four sutures flatten out the underlay patch and can be tied or removed with equal effect. The sutures are placed at 3, 6, 9 and 12 o’clock, which simplifies the procedure and ensures that the underlay lays correctly and is corrugation-free and tension-free, thereby providing a two-layer repair for those herniae with a high rate of recurrence. Both authors are independent surgeons who have no conflicts of interest with Ethicon Endo-Surgery. This report has not been published elsewhere; the information contained in it has recently been presented as a poster at the National Hernia Symposium in Birmingham, UK, 8 February 2006.     

疝环充填式无张力疝修补术治疗腹股沟疝193例报告

目的：探讨疝环充填式无张力疝修补术的临床疗效。方法：回顾性分析193例腹股沟疝无张力修补的临床资料。结果：本组病人采用局麻或硬膜外麻醉，平均手术时间38min，术后疼痛轻，恢复快，5～10d出院。复发1例。结论：疝环充填式无张力疝修补术创伤小，复发率低，应成为基层医院在行腹股沟疝修补术时的首选术式。     

双层Prolene网片修补成人腹股沟疝

目的总结自行设计的双层Prolene网片无张力修补成人腹股沟疝的手术经验和临床效果. 方法应用双层Prolene网片对腹股沟管后壁存在巨大缺损的35例患者行无张力疝修补术,观察术后患者自主能力的恢复、切口并发症、术后住院时间及复发率. 结果所有患者术后6 h就能下床活动,伤口无血肿、感染,术后住院时间2～3 d.随访3～24个月无复发. 结论双层Prolene网片无张力疝修补术具有操作方便,术后恢复快,并发症少,无复发率等优点,是一种适用于腹横筋膜存在明显薄弱或巨大缺损患者的理想的疝修补术.     

3DP补片和PHS补片修补腹股沟疝体会(附106例报告)

目的:探讨3DP和PHS 补片修补腹股沟疝的疗效.方法:回顾性分析2009年1-8月应用3DP和PHS补片行开放性前入路腹膜前修补术的106例腹股沟疝患者的临床资料.结果:106例患者平均手术时间(50±12)min,平均术后住院时间(41±14)d.患者伤口均一期愈合,无感染发生.术后平均随访20个月(18～26个月...     

裁剪式双层prolene网片在老年腹股沟疝无张力修补术中的应用

目的 探讨裁剪式双层prolene网片在老年腹股沟疝无张力修补术中的临床应用价值。方法 对1997年7月至2005年7月应用裁剪式双层prolene网片行老年腹股沟疝无张力修补术56例的临床资料进行回顾性分析。结果 56例中，原发性腹股沟疝19例（33．9％），复发性腹股沟疝37例（66．1％）。巨大疝环12例（21．4％），伴发其他疾病44例（78．6％）。并发症发生率为10．7％（6／56）。平均手术时间45min；平均住院3．2d；随访6个月至8年，无术后复发。结论 应用裁剪式双层prolene网片进行腹股沟疝无张力修补术，符合老年腹股沟疝的解剖特点和“个体化”要求，尤其适合于老年巨大疝环者或复发性疝。由于操作简便、安全和经济等特点，易于广泛推广。     

疝环充填式无张力疝修补术在高危易复发性腹股沟疝中的应用

目的：评价应用疝环充填式无张力疝修补治疗高危易复发性腹股沟疝的价值。方法：1999年4月－2002年4月，用美国巴德公司产品（PerFix)实施疝环充填式无张力疝修补术治疗高危易复发性腹股沟疝60例，包括高龄疝8例，同侧并存疝2例，双侧疝7例，复发疝15例，伴腹内压增高的腹股沟疝46例。结果：全组均痊愈出院，平均住院6d，无死亡病例，手术时间平均44.6min。术后34例（56．7％），病人在12h mw gh ysi ,3周后恢复日常活动。术后并发短暂性尿潴留8例（13．3％），均在48－72h恢复正常。全组病例均未发生切口感染。术后随访2个月－2年，2列复发（3．3％）。结论：本法具有适应证宽，操作简便易行，省时，复发率低，术后恢复快，值得推广应用。     

Inguinal hernia treatment with the Prolene Hernia System in a Dutch regional training hospital

Introduction In this retrospective study results from inguinal hernia repair with the Prolene Hernia System (PHS) in a regional training hospital were analysed. Patients and methods One-hundred and seventy-eight primary inguinal hernias and thirty-nine recurrent hernias (initial non-mesh repair) were treated with the PHS. The primary endpoint was the recurrence rate. Secondary endpoints were short-term and long-term complications. Pain was evaluated by use of a visual analog scale (VAS, 0–100), and a short-form 36-item questionnaire was used to assess postoperation quality of life. All patients visited the outpatient clinic for a physical examination (100% follow-up). Results After a median follow-up of 32 months four patients were diagnosed with recurrent herniation (1.8%), three after primary hernia repair (1.6%) and one after recurrent hernia repair (2.6%). Three superficial wound infections (1.3%), three haematomas needing surgical evacuation (1.3%), and two lesions of the spermatic cord (0.9%) were diagnosed. Seven patients (3.2%) suffered from persistent pain (VAS > 40). Average VAS score was 13 (0–80) >24 months after surgery. Conclusion In a regional training hospital, primary and recurrent inguinal hernias were treated with low recurrence and few complications by use of the PHS.     

Inguinal Hernia Repair via Application of Mesh in Front of and behind the Fascia Transversalis

The aim of this study was to compare mesh placement in front of the fascia transversalis and behid the fascia transversalis via inguinal incision. We evaluated the results of 106 inguinal hernia cases treated with polypropylene mesh applied via the anterior approach between December 2004 and January 2010. Using the anterior approach, the mesh was placed preperitoneally behind the fascia transversalis in 51 of the patients, whereas in the other 55 patients the mesh was placed in front of the fascia transversalis. Mean duration of surgery was shorter in the patients in which the mesh was placed behind the fascia transversalis (60 min vs. 75 min) (P < 0.05). In all, 8 patients (7.5%) had postoperative complications, including hematoma (n = 4), seroma (n = 2), scrotal edema (n = 1), and orchitis (n = 1). There weren''t any significant differences in the complication rate between the 2 groups of patients (P > 0.05). During a mean 44-month follow-up period (range: 12–72 months), no recurrence was observed. In conclusion, there weren''t any significant differences between the 2 methods of inguinal hernia repair, other than the duration of surgery.     

Local Anaesthetic Inguinal Hernia Repair Performed Under Supervision: Early and Long-Term Outcomes

INTRODUCTION

Local anaesthetic inguinal hernia repair may be technically demanding. There are minimal data regarding the outcomes of local anaesthetic hernia repair by trainees in comparison with consultants.

PATIENTS AND METHODS

All consecutive local anaesthetic repairs performed by trainees and one consultant over a 9-year period were reviewed. Operation time, volume of local anaesthetic used, early and long-term complications were assessed. A postal survey was conducted to assess chronic groin pain and satisfaction rates.

RESULTS

A total of 369 repairs were reviewed of which 265 repairs were performed by the consultant and 104 by trainees. The male-to-female ratio was 25:1 and the median age of the study group was 61 years (range, 18–93 years). The volume of local anaesthetic used was significantly higher for trainees than the consultant (42 ml versus 69 ml; P = 0.03). The operative time for the consultant and the trainees was 35 min and 40 min (P = 0.8). The day-case rate was higher for the consultant than the trainees (84% versus 69%; P = 0.02). Three patients operated by trainees required conversion to a general anaesthetic repair. No difference was noted in chronic groin pain (consultant 28% versus trainees 32%; P = 0.52) on the postal survey. The median follow-up was 5 years (range, 2–7 years).

CONCLUSIONS

Local anaesthetic inguinal hernia repair can be performed safely by surgical trainees under consultant supervision with minimal short- and long-term morbidity. A large volume dilute solution of Lignocaine and Marcaine is recommended when hernia repair is undertaken by trainees.     

Hernia recurrence following inguinal hernia repair in children

Purpose

We aimed to describe the incidence, timing, and predictors of recurrence following inguinal hernia repair (IHR) in children.

Evaluation of the Rebound Hernia Repair Device for Laparoscopic Hernia Repair

Background:

The characteristics of the ideal type of mesh are still being debated. Mesh shrinkage and fixation have been associated with complications. Avoiding shrinkage and fixation would improve hernia recurrence rates and complications. To our knowledge, this is the first study of a device with a self-expanding frame for laparoscopic hernia repair.

Methods:

Six Rebound Hernia Repair Devices were placed laparoscopically in pigs. This device is a condensed polypropylene, super-thin, lightweight, macro-porous mesh with a self-expanding Nitinol frame. The devices were assessed for adhesions, shrinkage, and histological examination. Laboratory and radiologic evaluations were also performed.

Results:

The handling properties of the devices facilitated their laparoscopic placement. They were easily identified with simple x-rays. The mesh was firmly integrated within the surrounding tissue. One device was associated with 3 small adhesions. The other 5 HRDs had no adhesions. We noted no shrinkage or folding. All devices preserved their original size and shape.

Conclusions:

At this evaluation stage, we found that the Rebound Hernia Repair Device may serve for laparoscopic hernia repair and has favorable handling properties. It prevents folding and shrinkage of the mesh. It may eliminate the need for fixation, thus preventing chronic pain. The Nitinol frame also allowed radiologic evaluation for gross movement. Further studies will be needed to evaluate its clinical application.     

普里灵疝装置在局麻下腹股沟疝无张力修补术中的应用

目的探讨局麻下普里灵疝装置(PHS)在腹股沟疝无张力修补中应用的临床经验和疗效。方法回顾性分析38例患者经腹股沟切口腹膜前间隙置入普里灵疝装置(PHS)进行腹股沟疝修补术的病例,观察麻醉效果、手术时间、住院时间、住院费用及随访观察术后并发症及复发情况。结果全部采用局麻,单侧手术时间35～50 min,平均45 min,术后切口疼痛较明显的3人,均为中年患者。平均住院时间2～4 d。术后平均随访6～10个月无复发,无明显异物感,阴囊血肿2例。结论应用普里灵疝装置(PHS)修补腹股沟疝手术针对耻骨肌孔进行修补,具有手术修补范围大、术后恢复快、并发症少、住院时间短、术后复发率低等优点,与传统手术相比是一种更为理想的手术方式。