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

ABSTRACT

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.