Three-dimensional Mesh Repair

Three-dimensional mesh devices such as PROLENE* polypropylene Hernia System and PROLENE* 3D Patch polypropylene Mesh (both manufactured by ETHICON Products Worldwide, a Johnson & Johnson company) - have revolutionized the repair of hernias by building upon the advantages of the earlier tension-free techniques and making them even more effective.

PROLENE hernia system a "3-in-1" design (meaning that it incorporates three of the most widely used and accepted repair techniques into one single device) consist of three components integrated into one device:

• An underlay patch that provides an effective posterior repair on the inside of the abdominal wall, much like laparoscopic repair.
• An onlay patch that lays over the abdominal wall, much like a flat mesh repair
• A low-profile connector that connects the underlay patch on the onlay patch. This connector virtually eliminates the possibility of the device from moving, or migrating, thus significantly reducing the potential for recurrence.

The system sandwiches tissue between two layers of mesh, which supplements potentially weak areas of the abdominal wall and minimizes the chances of getting another hernia in the same area. The patch helps the body heal by acting as a matrix for tissue ingrowth.

Advantages:

• Patient comfort
• Virtually zero chance of migration
• Little suturing, reducing the risk of nerve damage that could lead to pain
• Can be done under local or regional anesthesia
• Takes typically about 20-40 minutes⁴
• Quick recovery and return to normal activities
• Extremely low recurrence rates⁵

Disadvantages

·         Some surgeons may not yet be trained to perform three-dimensional mesh repairs\

Surgical technique

·         An oblique 4-5 cm skin incision was made in the inguinal region, and the inguinal canal was opened in layers.

·         The cord structures were looped up in the region of the pubic tubercle and held.

·          The cremaster was incised and the cord structures and hernial sac were dissected from it by blunt and sharp dissection.

·         The hernial sac was then delineated and dissected free from the cord structures.

·         Indirect sacs were inverted and reduced into the peritoneal cavity, or alternatively twisted, transfixed and excised.

·         The transversalis fascia covering the posterior wall of the inguinal canal was cut open for a length of 2 cm.

·         With blunt dissection using a finger and gauze, the preperitoneal space of Bogros was dissected out to create a plane for the underlay part of the mesh.

·          The underlay patch was spread out in the preperitoneal space created  and the defect in the transversalis fascia was narrowed with one or two interrupted sutures of 2-0 polypropylene.

·         In patients with a lax internal ring, the preperitoneal plane was created by passing a finger or a piece of gauze through the internal ring itself.

·         The onlay mesh was then spread out over the posterior wall of the inguinal canal  This was fixed using 3-4 interrupted sutures of 2-0 polypropylene.

·         Haemostasis was achieved and the inguinal canal closed in layers.