Preperitoneal inguinal hernioplasty with ULTRAPRO versus PROL

ENE mesh

Chei Mei medical center

Uen Yih-huei

Introduction (I)1. PROLENE Hernia System (PHS) has been developed to impr

ove the result of hernioplasty . However, it is difficult to definitely deploy PHS's underlay patch with surgical methods

Underlay patch

Onlay patch

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

underlay "pocket“ graft

PHS

additional patch

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

underlay "pocket“ graft

PHS

additional patch

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

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

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

outer layer: U mesh

inner layer

: P mesh

PROLENE group

Material and Methods (II)

2.Prophylatic antibiotics: Cephazoline I gm

IV preop

3.Regular OPD FU Q6 months ( at least 2 years )

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

Table (I) Patient characteristics ＊

PROLENE group

(n=40)

ULTRAPRO group

(n=41)

Age (year) 32 ± 4 31 ± 5

Sex (M / F) 38 / 2 39 / 2

Hernia type

Indirect 20 21 Direct 19 19 Femoral 1 1

FU duration (month) 30 ± 6 31 ± 5

＊ Insignificant difference between both groups

Table (II) Results

0

1

0

0

0

1

38.7 ± 5.3

44.3 ± 3.9

ULTRAPRO group

( N = 41 )

0 Post OP recurrence

*Student’s t test

**Chi-square test

0Wound infection

1Wound hematoma

0Intestinal obstruction

1 Hydrocele

>0.052Morbidity**

>0.0537.6 ± 4.7Direct hernioplasty

>0.0543.2 ± 5.7Indirect hernioplasty

OP time (mean ± SD)*

P valuePROLENE group

( N = 40 )

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

Discussion (II) • Problems encountered during anterior preperit

oneal 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 ! )

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

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.

Thanks for your attention!!