Page 35 - herina surgery and possible lawsuits

Figure 12: Plugstein repair (Onlay patch on
the inguinal floor)

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

The recurrence rate for direct or pantaloon
defects is 2% and for indirect defect it is less
than l°/« on the follow up of 4 years.[71]

Prolcne Hernia System

PROLENE Hernia System (PHS) is bi-laycr polypropylene mesh introduced by Gilbert in
1998. Three-in-one device having round disc for preperitoneal repair, plug effect of
connector, and oblong shaped onlay component. The Prolene Hernia System (PHS) was
developed as an option inguinal hernia repair that combined the benefits of anterior and
posterior mesh components. For using this system the inguinal canal is approached anteriorly
as described for the Lichtenstein repair. The indirect sac is dissected and ligated or inverted,
and a preperitoneal pocket is created through the internal ring or posterior wall using sponge.
The posterior portion of the PHS is then deployed in the preperitoneal space. The anterior
portion positioned and sutured much like the onlay patch in the Lichtenstein repair. A lateral
slit made in the PHS mesh to accommodate the cord and relocate the internal ring. The lateral
anterior portion of the PHS is then deployed under the external oblique aponeurosis
laterally.[72]

Figure 13: (A) Prolene hernia system anterior view. (B) Prolene hernia system posterior view.

(Courtesy of Ethicon, Inc.. Somerville, NJ and Surg Clin N Am 83 (2003)).

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