经腹壁行腹膜前鼠蹊疝气修补术课件_1

Anteriorpre peritonealinguinalhernioplasty經腹壁行腹膜前鼠蹊疝氣修補術 溫義輝奇美醫學中心Yih HueiUen MDDivisionofGeneralSurgery DepartmentofSurgery ChiMeiFoundationMedicalCenter Tainan Taiwan ROC Design I Modifieddevice techniqueofPHS AnimprovedmethodfordeployingthepolypropyleneunderlaypatchofthePROLENHerniaSystem AmericanSurgeon2007May Yih HueiUen通過專利審核 Fig 1 TheproceduresofdevelopmentofamodifieddeviceofPHS Fig 2 Theproceduresofintra pocketmanipulation Table1 Results ComparativeLaparoscopicEvaluationofthe Original versus Modified DesignofPROLENEHerniaSysteminAPorcine groinHernia RepairModel Study II MaterialandMethod 30uncastractedmalepig averageBW 24Kg UnilateralanterioringuinalhernioplastyGroupOriginalPHS n 10 ModifiedPHSwithonlayfixation n 10 ModifiedPHSwithoutonlayfixation n 10 Hand assistedlaparoscopicstress loadingtestusingdynamometer Result I Thelaparoscopyofthepreperitoneallypositionedmeshprosthesis Result II Comparsionoftheresultsofstress loadingtest Burstingstrength lb P0 05Group1vsGroup3 10 57 0 46 23 99 0 89 10 20 1 11 Discussion I Specialdesignanduniquetechniqueof Modified PHS Harboringadeployingunderlay pocket graftwithapressurereceptionperimeterFixatingunderlaygrafttothefascialedgeUsinganarrowangledmetalpushertoperformintra pocketmanipulation FulldeploymentofunderlaygraftagainsttheinnersurfaceoftheinguinalfloortocoverentireMPO Pascal sprinciple SecureobliterationoffascialdefectIncreasedstabilityofdevicesSelfassessmentoftheadequacyofdeployment Discussion II Potentialadvantageof Modified PHSprosthesis Discussion III Thefixationstitchesofonlaypatchtraditionallyusedin Original PHScanbesubstitutedbythoseoffascialedgein Modified deviceifitisstrongenough Canpost operativepainbedecreased Discussion IV Hand assistedlaparoscopicstress loadingtestwithdynamometer FirstlyusedinassessmentofthestabilityofherniarepairprothesisAnusefultool goodexposure mimicnatureherniaprotrusion easymanipulationandhighaccuracy Conclusion Groinherniarepairwith Modified PHSdevice techniqueisasimpleandeffectivewaytoachievefulldeploymentofunderlaygraftalongpelvicanatomywithincreasedstability Design II Underlaypocketgraft enough TypeI PROLENEmeshTypeII ULTRAPRO partiallyabsorbable mesh UnderlaypocketgraftwithULTRAPRO partiallyabsorbable mesh Study III Randomizedcomparisonoftheclinicalresultofpre peritonealhernioplastywithPROLENEvsULTRAPROmeshunderlaypocketgraft Table1 Results Discussion Althoughlong termfollow upisneeded theearlyresultofpre peritonealhernioplastyusingULTRAPROmeshisasefficientasPROLENEanalogue Summary Underlaypocketgraft eitheralonguseorcombinedinPHSdevice canfacilitatetheresultofpre peritonealhernioplasty It sroleininguinalhernioplastywillbehigh lightenedbytheusageofULTRAPROmesh Reference 1 GilbertAI GrahamMF VoigtWJ Abilayerpatchdeviceforinguinalherniarepair Hernia1999 3 161 166 2 UenYH ComparisonlaparoscopicevaluationofthePROLENEherniasystemandthePerfixplug and patchdeviceinaporcinegroinherniarepairmodel JournalofLapar