Experience of Open Herniorrhaphy Using the PerFix(R) Plug for Patients with Recurrent Groin Hernias

PURPOSE: The recurrence of a groin hernia presents few surgical options for repair. We investigated the safety and efficacy of herniorrhaphy using PerFix(R) plug for patients with recurrent groin hernias. METHODS: Between October 2000 and December 2004, 30 herniorrhaphies for recurrent groin hernia were performed and followed-up. The operation time, length of hospital stay, time of analgesic use, complication rates, and recurrence were investigated. RESULTS: Surgery had been initially performed in 26 patients with the non-mesh method, and with mesh in 4 patients; 12 patients had a direct recurrence at the medial side of the inguinal area near the pubic tubercle, 7 patients had a direct recurrence at other sites, and 11 patients had an indirect recurrence. Eight patients had urinary retention and 2 patients had minor wound complications. Hospital stays and analgesic use were comparable to non-recurrent groin hernia operations, although operation time was significantly longer in recurrent group, and there were no recurrences during the 70 months of followup. CONCLUSION: Comparing open or laparoscopic preperitoneal approach, the PerFix(R) plug method is simple and effective for recurrent groin hernia repair.

Direct Comparison of PHS(R) and Perfix(R) Herniorrhaphy under Local Anesthesia

PURPOSE: The aims of this study were to evaluate the feasibility of local anesthesia in tension-free herniorrhaphy, using prosthetic mesh, and to directly compare PHS(R) and Perfix(R) herniorrhaphy under local anesthesia. METHODS: Patients with a groin hernia, who underwent tension-free herniorrhaphy (n = 107) under local anesthesia between March 2003 and February 2006, were included. PHS(R) (n = 63) and Perfix(R) (n = 44) meshes were randomly used, with no difference between the PHS(R) and Perfix(R) groups in relation to mean age, gender, number of combined diseases, body mass index (BMI), recurred hernia and types of hernia. RESULTS: Intraoperative analgesics and/or sedatives were used in 55 patients (51.4 %) where local anesthesia was insufficient. In a univariate analysis, the additional use of intraoperative analgesics and/or sedatives was related to the patient's age and BMI. The patients at an older age and with a lower BMI were more tolerant to local anesthesia. However, only the BMI was found to be a statistically significant factor from the multivariate analysis. There was no significant difference between the PHS(R) and Perfix(R) groups on the additional use of intraoperative analgesics and/or sedatives, the use of postoperative analgesics, length of hospital stay, complication and recurrence (P > 0.05). CONCLUSION: With tension-free herniorrhaphy using the PHS(R) or Perfix(R) mesh, local anesthesia was acceptable and securable, regardless of the mesh type used. Among these patients, those at an older age and with a lower BMI were more tolerant to local anesthesia.

Tension-free Herniorrhaphy Using PerFix(R) Plug: A Follow-up Report

BACKGROUND: Since the mid-1990s, PerFix(R) plug hernioplasty has become one of the mainstays of hernia surgery. We previously reported the preliminary results of the PerFix(R) plug hernioplasty in 2003. Here we report the results of a 5 year follow-up study of PerFix(R) plug hernioplasty. METHODS: From May 2000 to April 2005, 326 PerFix(R) plug repairs were performed. The operation times, lengths of hospital stay, visual analogue pain scales, time of analgesics use and complications and recurrence rates were evaluated prospectively. RESULTS: 326 cases underwent mesh-plug hernioplasties, 285 with inguinal hernias primary, 35 with recurrent hernias and 6 with femoral hernias. 218 and 101 cases were indirect and direct hernias, respectively. The mean age was 59.8 years. The male to female ratio was 289 : 15. Cardiovascular disease is the most common associated disease. The mean operation time was 31 minutes. The mean length of hospital stay was 2.5 days. The mean length of analgesics use, acetaminophen (1T: 300 mg p.o) and Nubaine (5 mg IM), were 1.89 and 0.5, respectively. Seventy-six (23%) cases developed a postoperative complication with urinary retention being the most common. During the follow up period from 12 months to 6 years, the overall recurrence rate was 0.6% (n=2). CONCLUSIONS: Tension-free repair of an inguinal hernia by PerFix(R) plug is a simple and secure method with less pain, quick operation times, short hospital stays, low complication rates and low recurrence rates.

Tension-free Herniorrhaphy Using PerFix(R) Plug: A Preliminary Report

PURPOSE: The PerFix(R) plug is preformed as a Marlex mesh hernia plug, and consists of a fluted outer layer combined with an inner arrangement of eight mesh "petals." In contrast to hand-rolled hernia plugs, which can collapse on themselves, the PerFix(R) plug's petals maintain the device's open conelike shape. The fluted design allows the plug to more readily conform to the configuration of any indirect or direct defect. METHODS: Bewteen January 1996 and April 2000 126 conventional herniorrhaphies (C group: Bassini: 23, Shouldice: 15, McVay: 5, Lichtenstein: 83) were performed, and between May 2000 and April 2002, 124 PerFix(R) plug repairs (P group) were completed. The operation times, lengths of hospital stay, visual analogue pain scales, time of analgesics use, and complication and recurrence rates were compared between these two groups. RESULTS: The operation times and lengths of hospital stay for groups C and P were 56.4 vs. 31.1 minutes and 4.4 vs. 2.8 days, respectively, so where significantly shorter in the P group (P<0.01). The times of use for the analgesics, AAP and Nubaine, were 6.6 vs. 0.6 times and 1.7 vs. 0.9 times, in group C and P, respectively, so were significantly fewer in the P group (P<0.01). There were 5 recurrences (3.9%) in the C group during the follow up period (2~6 years), but there were none in the P group during the follow up period (5 months~2 years). The complications were similar in both groups. CONCLUSION: Compared with conventional surgical techniques, including the Lichtenstein tension free method, the PerFix(R) plug method is the most simple, and shows superiority in the following areas; the operation time, length of hospital stay, times of analgesics use and recurrence. However, with regard to the recurrence, longer follow up and observation periods are required.