Post on 18-Jan-2016
transcript
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!!