Inguinal Hernia Repair using Prolene Hernia System – a Simplified Technique for Beginners

Introduction: Surgical repair of the inguinal hernia is themost common general surgery procedure performed today.Even today inguinal hernias pose a great burden on thehealthcare system. Hence even modest improvements inclinical outcomes are warmly welcomed. This study describesthe technique of Prolene Hernia System (PHS) in its simplifiedform for the beginners to learn it quickly.Material and methods: A prospective study was conductedin 50 patients in a tertiary centre from April 2010 to Oct 2011for period of 18 months. Patients’ demographic data wascollected and patient selected as per the selection criteria. ThePHS mesh repair was performed as described by Gilbert etal3 with some simplification and modification as described.Absorbable sutures were used to fix the mesh in the describedfour stitch technique. All data collected from study wereentered in the database for statistical analysis.Results: All participants were males and most of them werefrom manual labour background (38 patients (76%). Most ofthe patients belonged to 26-35 year age group (18 patients(36%). 40 participants were found to have indirect hernias(80%). Right sided hernia was found more common (33patients (66%). The mean duration of surgery was 31.96 min(SD – 2.303). Intraoperative complication included 2 cases ofnerve damage (4%). The mean pain score in first 24 hours was6.82/10 (SD – 1.848). None of the patients reported recurrenceof hernia (0% recurrence).Conclusion: The PHS mesh, consisting of an underlay patch,an overlay patch, and a joining connector, has potentialbenefits over the traditional Lichtenstein, Mesh Plug Repair(MPR) and Laparoscopic repairs. The PHS mesh providescomplete coverage of the entire myopectineal orificethrough the underlay placed in the preperitoneal space, theoverlay placed in the inguinal canal and the connector whichmaintains the mesh in position. In our study we also found thatuse of absorbable sutures helped in relieving neuralgia andlessened chronic groin pain by causing less permanent nerveentrapment without affecting the recurrence rate.

Comparative Study between Lichenstein Mesh Repair and Prolene Hernia System in the Management of Uncomplicated Inguinal Hernia.

Introduction: Inguinal hernia repair is one of the most commonly performed surgeries in the world. The surgeon today has the liberty to select from a wide variety of prosthetic meshes. Whether the newer meshes can replace the time-tested Lichtenstein mesh repair is a subject of ongoing debate. Objectives: To determine the feasibility of using the Prolene Hernia System (PHS) and to compare it with Lichtenstein repair for open tension-free repair of inguinal hernias. Materials and Methods: Lichtenstein mesh repair and PHS repair were performed on 60 inguinal hernias in 55 patients in KIMS, Hubli. All these patients were followed up for a period of 2-year. Results: The mean age of the population in PHS group is 49.90 ± 15.93 years and in Lichtenstein group is 50.63 ± 1.19 years. The mean duration of surgery in PHS group is 46.67 ± 6.48 min and in Lichtenstein group is 46.33 ± 7.18 min (P > 0.05). Most of the surgeries were completed between 41 and 50 min. The mean duration of post-operative hospital stay in PHS group is 3.63 ± 1.22 days and in Lichtenstein group is 4.10 ± 2.25 days (P > 0.05). 1 (3.3%) patient in PHS group and 2(6.7%) patients in Lichtenstein group had seroma (P > 0.05). 1 (3.3%) patient each in PHS group and in Lichtenstein group had wound infection (P > 0.05). 2 (6.7%) patients in PHS group and 3 (10%) patients in Lichtenstein group had groin pain which lasted for >3 months (P > 0.05). None of the patients in both the groups had recurrence till the time of publication of results. Conclusion: Lichtenstein mesh repair continues to be an effective means for treating inguinal hernia with minimal complications. PHS mesh repair is a suitable alternative to the time-tested Lichtenstein mesh with comparable outcomes and can be suggested in affordable patients as it eliminates the possibility of all types of hernia.

Comparative Analysis Between Totally Extraperitoneal Repair and Prolene Hernia System at a Single Institute

PURPOSE: Laparoscopic hernioplasty is a standard procedure used for the repair of inguinal hernia. However, due to the technical and anatomical complexities associated with this treatment and the requirement for long surgery time as compared to other methods, the use of laparoscopic hernioplasty remains questionable. This study compared the results of two surgical repair methods: totally extraperitoneal (TEP) hernia repair and the Prolene hernia system (PHS). METHODS: A retrospective review was conducted of all patients who underwent TEP (154 cases) and PHS (126 cases) from January 2008 to December 2010 as performed by a surgeon at our hospital. Operating time, length of hospital stay, recurrence rate, surgical site infection rate, wound hematoma rate and scrotum swelling rate were all compared. RESULTS: For the TEP treatment cases the mean operating time was 59.5 min, mean hospital stay was 4.9 days, there were 2 cases (1.3%) of recurrence, one case (0.6%) of surgical site infection, 20 cases (12.9%) of wound hematoma and 8 cases (5.2%) of scrotum swelling. In the case including treatment by PHS the mean operating time was 39.6 min, mean hospital stay was 5.4 days, there were no cases of recurrence, there were 2 cases (1.7%) of surgical site infection, 11 cases (9.5%) of wound hematoma and 12 cases (10.3%) of scrotum swelling. There were no cases involving neurogenic pain or chronic pain. CONCLUSION: Both PHS and TEP are safe and effective procedures for repairing inguinal hernia. Thus, with consideration of variable patient conditions and other factors, either PHS or TEP are recommended as viable procedures for treating inguinal hernia.

Hernioplastía incisional con Prolene Hernia System®: reporte de casos / Incisional hernia repair using Prolene Hernia System®: experience in five cases

Background: Incisional hernias are a potential complication of abdominal surgery. Tensión free surgical techniques using prosthetic materials are the ideal treatment. Aim: To report the preliminary experience in incisional hernia repair using the Prolene Hernia System® from Ethicon Endo-Surgery (Bracknell, UK). Material and Methods: Report of four operated males and one female aged 48 +/- 7 years. Results: Surgical time ranged from 30 to 55 minutes. Postoperative hospital stay was 24 hours. No patient had postoperative complications. No hernia relapse has been detected in the outpatient follow up. Conclusions: These preliminary results show a successful incisional hernia repair using the Prolene Hernia System® from Ethicon Endo-Surgery.

Introducción: La hernia incisional es una complicación potencial de cualquier cirugía laparotómica o laparoscópica. El tratamiento de las hernias incisionales es quirúrgico. En la actualidad, las técnicas libres de tensión con la utilización de materiales protésicos constituyen la elección en el tratamiento de la hernia incisional. Objetivo: Presentar un reporte preliminar de los resultados obtenidos en el tratamiento de hernias incisionales con Prolene Hernia System® de Ethicon Endo-Surgery (Bracknell, UK). Materiales y Método: Reporte de casos. Se describe la técnica quirúrgica utilizada y los criterios de selección para pacientes con hernia incisional que han sido tratados quirúrgicamente utilizando como material protésico Prolene Hernia System® a partir de Octubre de 2006. Los pacientes han tenido un seguimiento clínico periódico durante 2 años. Se reportan los resultados en términos de morbilidad y recidiva. Resultados: El reporte consta de 5 pacientes, 4 mujeres y 1 hombre. La edad promedio es de 48 + 6,39 años. El tiempo operatorio promedio de 45 minutos con una estadía hospitalaria de 24 horas. No se presentaron complicaciones en el período postoperatorio. Durante el seguimiento no se ha presentado recidiva hemiaria. Conclusiones: Prolene Hernia System® es una prótesis que proporciona un doble soporte de la pared abdominal, y teóricamente podría mejorar los resultados de la reparación hemiaria sin tensión. Estos resultados deben ser evaluados mediante estudios con un diseño apropiado a terapia y con seguimiento a largo plazo.

Clinical Analysis of Inguinal Hernia in Adult Using Prolene Hernia System

PURPOSE: The aim of this study was to detail clinical experiences with a type of tension-free herniorrhaphy using the prolene hernia system (PHS) and analyze the system's usefulness. METHODS: We retrospectively reviewed the medical records of 122 patients who underwent an inguinal hernia repair using PHS between March 2004 and August 2008. RESULTS: There were 116 male and 6 female patients ages 14 to 99; 79 indirect, 33 direct, 10 pantaloon hernias. The right inguinal hernias were more frequent (64.7%). The mean operative time for inguinal hernia repair using PHS was 45.2+/-1.5 minutes and the mean postoperative hospital stay was 3.5+/-1.5 days (101+/-82.9 hours). The most frequent combined disease was hypertension. The most frequent complication of PHS repair was hematoma. The mean number of used analgesics was 3.1+/-3.3. There were no postoperative recurrences. CONCLUSION: Tension-free herniorrhaphy using PHS is thought to be a useful method of inguinal hernia repair in adults because it offers lower postoperative pain, shorter operation time and shorter postoperative hospital stay.

Prolene hernia system in the tension-free repair operation of inguinal saddle hernia / 国际外科学杂志

Objective To explore the therapeutic efficacy and operation experience of Prolene Hernia System (PHS) in the tension-free repair operation of inguinal saddle hernia. Methods All 41 cases using PHS were selected as the subjects of this study and the results were analyzed. Results All patients were performed operation under the local anesthesia, and lasted from 25 min to 60 min. They had been keeping in ward for observation from 24 h to 72 h. No serotal swelling, hematoma, and incisional wound infection hap-pened after the operation. The follow-up time had been lasting from 6 months to 42 months, and none of pa-tients catehed a relapse or had the sensation of the foreign bodies. Conclusions Using PHS is safe and ef-fective in the tension-free repair operation, and it is more suited to inguinal saddle hernia. The key of opera-tion success is attaching importance to operation skills.

Comparing of Complications of Inguinal Hernia Repair Using Prolene Hernia System

PURPOSE: A tension-free hernia repair using mesh is considered the standard method. A prolene hernia system (PHS) is a more recently introduced hernia-repair device in Korea. We compared complications of beginners' PHS operation with those of experts in our department. METHODS: We retrospectively analysed 448 cases of herniorrhaphy using PHS from December 2002 to August 2007. We compared complication of 150 early cases and 150 late cases. RESULTS: There were 394 male and 54 female patients with ages 19 to 82: 321 indirect, 83 direct, 7 femoral, 4 pantaloon hernias. The most frequent complication of PHS repair was hematoma and wound swelling. The 150 early cases' complications included 7 hematoma and 9 wound swelling. The 150 late cases' complications included 7 hematoma and 8 wound swelling. There was no difference between early and late complications. CONCLUSION: In comparing complications of 150 early and late cases, there was no difference.

A Tension-free Herniorrhaphy Using the Prolene Hernia System: Clinical Experiences

PURPOSE: The aim of this study was to detail clinical experiences with a new type of tension-free herniorrhaphy using the Prolene Hernia System (PHS) and analyze the system' usefulness. METHODS: We reviewed 48 cases of herniorrhaphy using PHS and 45 cases of conventional herniorrhaphy retrospectively by reviewing the medical records of patients undergoing either procedure between January 2000 and February 2005. RESULTS: There was no significant difference in the operation time (P=0.054) or the length of hospital stay (P=0.138) between the groups. However, the need for analgesic therapy in the PHS group was less than in the control group (P= 0.008). There were no serious postoperative complications, but wound complications occurred more often in the PHS group (6 seromas and 2 hematomas), and urinary retention occurred more frequently in the control group. The recurrence rate in the control group was 2.2% (1/45), but there were no recurrences in the PHS group for 46 months. CONCLUSION: Herniorrhaphy using the PHS is safe and effective as conventional surgery. It can be carried out under local anesthesia more easily, and it is less painful than the conventional surgery. We suggest that the PHS be widely adopted as a method of tension-free herniorrhaphy.

120 Cases of Hernia Repair with Bilayer Patch (Prolene Hernia System)

PURPOSE: A tension-free hernia repair using a mesh is considered to be the standard method. The Prolene Hernia system (PHS) is a more recently introduced hernia-repair device in Korea. We report the results of hernia repair using the PHS in 120 cases at our department. METHODS: We retrospectively analyzed 120 cased of herniorrhaphy using PHS. between December 2002 and September 2004. RESULTS: There were 104 male and 16 female patients with a mean age of 54 years: 85 indirect, 32 direct, 2 femoral, and 2 pantaloon hernias. There were 20 cases postoperative complications: including 6 hematoma, 3 seroma, 3 wound swelling, 2 dysuria, 2 testicular swelling, 1 scrotal swelling and 1 peritoneal irritation. There were no postoperative infection and recurrence. The median operative time was 54.6 min (range 23~165min). We thought that lesser than 30 cases need to be performed to become skillful in the hernia repair with PHS. CONCLUSION: Hernia repair with PHS is easy to learn and to perform. And this procedure has lesser postoperative complications.

Application of Prolene Hernia System in day case tension-free inguinal hernia repair / 中国微创外科杂志

Objective To investigate the application of Prolene Hernia System (PHS) in day case tension-free inguinal hernia repair under local anaesthesia. Methods One hundred and seventy patients with inguinal hernia underwent day tension-free repair under local anaesthesia by using PHS (manufactured by Johnson Co., Ltd.) from February 1998 to February 2003. Results The operation time was (15～68) min, with a mean of 35 min. The patients remained in the hospital for (3～20) hours (mean, 8 hours), with slight wound pain and tugging after operation but no need for analgesics. No wound infection or urinary retention occurred. Scrotal hydrocele was found in 4 cases. There were no recurrence or sensation of foreign body in a follow-up period for (2～14) months (mean, 8 months). Conclusions PHS in day case tension-free inguinal hernia repair under local anaesthesia is safe and reliable.