经腹壁行腹膜前鼠蹊疝气修补术课件

Anterior pre-peritoneal inguinal hernioplasty 經腹壁行腹膜前鼠蹊疝氣修補術 溫義輝 奇美醫學中心 Yih-Huei Uen, MD Division of General Surgery, Department of Surgery, Chi Mei Foundation Medical Center, Tainan, Taiwan, ROC. Design(I) nModified device /technique of PHS: nAn improved method for deploying the polypropylene underlay patch of the PROLEN Hernia System: nAmerican Surgeon 2007 May, Yih-Huei Uen n通過專利審核 Fig. 1: The procedures of development of a modified device of PHS. Fig. 2: The procedures of intra-pocket manipulation Table 1. Results 0 0 0 0 1 1 35.7 5.4 41.3 3.2 Modified group N=184 0.051 Post OP recurrence (follow up2years) *Students t test *Chi-square test 0Mesh extrusion 0Hydrocele 0Intestinal obstruction 0 Wound infection 0.051Morbidity* 0.05 Obliteration of fascial defect 03 moderate or marked wrinkle 107 flat to slight wrinkle 0.05 Group1 vs Group 3 10.57 0.46 23.99 0.89 10.20 1.11 Discussion ( I ): Special design and unique technique of “Modified” PHS Harboring a deploying underlay “pocket” graft with a pressure reception perimeter Fixating underlay graft to the fascial edge Using a narrow angled metal pusher to perform intra-pocket manipulation nFull deployment of underlay graft against the inner surface of the inguinal floor to cover entire MPO (Pascals principle) nSecure obliteration of fascial defect nIncreased stability of devices nSelf assessment of the adequacy of deployment Discussion ( II ):Potential advantage of “Modified” PHS prosthesis Discussion ( III ): nThe fixation stitches of onlay patch traditionally used in “Original” PHS can be substituted by those of fascial edge in “Modified”device if it is strong enough. nCan post-operative pain be decreased? Discussion ( IV ): nHand-assisted laparoscopic stress-loading test with dynamometer: nFirstly used in assessment of the stability of hernia repair prothesis nAn useful tool :good exposure, mimic nature hernia protrusion, easy manipulation and high accuracy Conclusion: nGroin hernia repair with “Modified” PHS device/ technique is a simple and effective way to achieve full deployment of underlay graft along pelvic anatomy with increased stability. Design(II) nUnderlay pocket graft ( enough! ) Type I: PROLENE mesh Type II: ULTRAPRO (partially absorbable) mesh nUnderlay pocket graft with ULTRAPRO (partially absorbable) mesh Study(III) nRandomized comparison of the clinical result of pre-peritoneal hernioplasty with PROLENE vs ULTRAPRO mesh underlay pocket graft Table 1. Results 0 0 0 0 0 0 38.7 5.3 44.3 3.9 ULTRAPRO group N=30 0 Post OP recurrence (short-term follow up) *Students t test *Chi-square test 0Wound infection 1Wound hematoma 0Intestinal obstruction 0 Mesh extrusion 0.051Morbidity* 0.0537.6 4.7Direct hernioplasty 0.0543.2 5.7Indirect hernioplasty OP time (mean SD)* P value PROLENE group N=28 Discussion nAlthough long-term follow-up is needed, the early result of pre-peritoneal hernioplasty using ULTRAPRO mesh is as efficient as PROLENE analogue. Summary nUnderlay pocket graft, either along use or combined in PHS device, can facilitate the result of pre-peritoneal hernioplasty. Its role in inguinal hernioplasty will be high- lightened by the usage of ULTRAPRO mesh. Reference n1. Gilbert AI, Graham MF, Voigt WJ. A bilayer patch device for inguinal hernia repair. Hernia 1999;3:161-166. n2. Uen YH. Comparison laparoscopic evaluation of the PROLENE hernia system and the Perfix plug-and-patch device in a porcine groin hernia repair model. Journal of Laparoscopic 14(6):363-373. n3. Murphy JW. Use of the prolene hernia system for inguinal hernia repair: retrospective, comparative time analysis versus other inguinal hernia repair systems. Ameri