Page 34 - herina surgery and possible lawsuits

• The PerFix Plug repair of direct and indirect hernias is an adaptation of Gilbert's free-
formed umbrella-shaped plug, which initially used as a plug in the internal ring for
treatment of indirect inguinal hernias.[71]

Figure 10: Gilbert's Free PerFix Plug repair
(free-formed umbrella-shaped plug)
A PerFix plug situated in the internal ring.
Within the insert is illustrated the toggle
bolt like action of a PerFix plug as the
mesh spreads out beneath the crura of the
internal ring or the transversalis fascia of a
direct defect.

(Courtesy: I.M. Rutkow / Surg Clin N Am
83 (2003))

• The PerFix Plug currently manufactured to place in the internal ring and fixed with
sutures to the surrounding tissues. When a direct hernia is present, the PerFix Plug
used in a similar fashion. When pantaloon or unusually large direct hernias are

present, multiple plugs are sewn together to repair the defect. In addition to the plugs,
an onlay patch also provided, which can be used with or without sutures over the
posterior wall and around the spermatic cord lateral to the internal ring. Increasing

numbers of surgeons use a PerFix plug and “ reinforce” the repair by securing an
onlay patch in a manner similar to that of Lichtenstein (Figure. 11). This hybridization
of two well-known,tension-free techniques is termed a “ Plugstein” repair. [71]

Figurell: Plugstein repair

Perfix Plug Flower- shaped
polypropylene mesh plug with
multiple petals, and onlay graft
with slit to accommodate the
spermatic cord.

(Courtesy: I.M. Rutkow / Surg
Clin N Am 83 (2003))

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