Page 32 - herina surgery and possible lawsuits

hernias through complete exposure of prepentoneal area,[23] Doing so frequently
resulted in considerable suture-line tension, enough to require relaxing incisions.

Patients complained of considerable and prolonged postoperative pain and failure
rates became unacceptable. This procedure however, had value to surgeons by
demonstrating the strength of the superior pubic ligament and showing its utility in
large and difficult hernia repairs. It is the reliable structure to which prosthetic
material can be fixed, when a large defect must be spanned. Now for the laparoscopic
meshplasty, cooper’s hgament is the landmark to fix the mesh.

Figure 9: McVay (Cooper
ligament) repair

Showing intermittent suturing of
Cooper’s ligament with
transversus abdominis arch.

(Courtesy Nyhus & Condon’s
HERNIA, 5e, LWW)

Tension-Free Hernia Repairs:

• The most important advance in hernia surgery has been the development of tension-
free repairs. In 1944, D.E. Acquaviva of France presented the first use of a nylon

synthetic mesh to eliminate hernia and tension while leavmg a defect intact (Tension
free concept).[9] In 1958 Francis Usher had introduced polypropylene (Marlex 50) for
henna repair. Usher opened the posterior wall and sutured a swatch of Marlex mesh to

the undersurface of the medial margin of the defect (which he described as the
transversalis fascia and the conjoined tendon) and to the shelving edge of the inguinal
ligament. He created tails from the mesh that encircled the spermatic cord and secured
them to the inguinal hgament. The use of mesh was restricted for difficult or recurrent

henna. [9, 25]

The most common prosthetic open repairs done today are the Kugel patch repair, the
Lichtenstem onlay patch repair, the PerFix plug and patch repair, and the PROLENE Hernia

System bilayer patch repair.

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