A Laparoscopic Intraperitoneal Onlay Mesh Technique for the Repair of an Indirect Inguinal Hernia

Abstract

ObjectiveThis study was done (1) to determine whether congenital indirect inguinal hernias in male pigs could be repaired by placing a polypropylene mesh prosthesis over the defect intra-abdominally, (2) to measure the incidence of adhesions between intra-abdominal viscera and the prosthesis with and without the adhesion barrier oxidized regenerated cellulose, (3) to determine the incidence of other complications, and (4) to assess the effect on fertility. Summary Background DataSeveral techniques for laparoscopic inguinal herniorrhaphy are currently being evaluated to determine whether there are advantages over conventional inguinal herniorrhaphy. Perhaps the most controversial is the intraperitoneal onlay mesh procedure (IPOM). Its advantage is its simplicity (in that the repair is accomplished by placing a prosthesis over the hernia defect intraabdominally, avoiding a groin dissection). Its disadvantage is the potential for complications because the prosthesis is in contact with the intra-abdominal viscera. MethodsIn male pigs, polypropylene mesh alone or polypropylene mesh plus the adhesion barrier oxidized regenerated cellulose (composite prosthesis) was fixed to the peritoneum surrounding the hernia defect. In phase 1 (6-week follow-up), two groups of 13 pigs each underwent herniorrhaphy at laparotomy or laparoscopy. In phase 2 (7.1-month follow-up), 21 pigs underwent laparoscopic herniorrhaphy. ResultsAll IPOM herniorrhaphies were successful. The prostheses adhered most frequently to the bladder, followed by small bowel, peritoneum, and cord structures. Prosthetic erosion into these organs was not observed. Laparoscopically placed prostheses in phases 1 and 2 had significantly less surface covered by adhesions (13% ± 13% and 19% ± 27%, respectively) and a lower adhesion tenacity grade (1.5 ± 0.9 and 1.3 ± 1.1, respectively) than those placed at laparotomy (44% ± 27% and 2.5 ± 0.7, respectively; p < 0.01). In phase 1, a histologic evaluation of laparoscopically placed specimens demonstrated significantly thinner above-mesh fibrotic tissue compared with the prostheses implanted at laparotomy (p < 0.04). In either phase, the use of the adhesion barrier did not produce any histologic difference between the polypropylene alone and the composite prosthesis. Fertility studies were performed in phase 2 and showed no adverse effects caused by either prosthesis. 144

Morphologic evaluation of the use of a latex prosthesis in videolaparoscopic inguinoplasty: an experimental study in dogs

“…However microscopic analysis of the two cases demonstrated vascular neoformation, an inflammatory reaction, collagen deposition without fibrosis and microcyst formation, but with partial incorporation of the biomembrane. This showed that the reduced thickness of the porous biomembrane was of some benefit, in agreement with literature reports 10,11,17,19 that demonstrated the need for pores in the prosthesis for intermingled fibroblast proliferation to occur with consequent incorporation. These facts suggest that a less thick biomemnbrane appears to be a factor influencing incorporation into adjacent tissues.…”

“…In a further attempt to improve the performance of the latex biomembrane, a new modification was introduced in its structure, rendering it porous, based on the results reported by Stoppa et al 7 , Fitzgibbons et al 19 , Dion and Morin 10 , McKernan and Laws 17 . The results obtained with the latex biomembrane with 1-mm thick polyamide in group 3 were similar to thouse obtained for the group implanted with latex with impermeable polyamide, demonstrating that the presence of pores in the biomembrane with thick porous polyamide did not contribute to improving the results regarding incorporation.…”

Use of Fibrin Sealant for Prosthetic Mesh Fixation in Laparoscopic Extraperitoneal Inguinal Hernia Repair

“…[1][2][3] The current methods of laparoscopic hernia repair involve the application of a preperitoneal prosthetic mesh over the hernia spaces, creating a tension-free repair. 4,5 The mesh is fixed in place using metal staples to prevent graft displacement, with consequent hernia recurrence. 6 Laparoscopic herniorrhaphy is not devoid of complications.…”

Cirugía mínimamente invasiva de la hernia inguinal

“…Quince años después es un procedimiento consolidado y con tecnología especializada. Presenta como ventajas un menor dolor y disconfort postoperatorio, una recuperación más rápida de la actividad física y laboral, la posibilidad de reparar hernias recidivadas en territorio virgen y bilaterales por la misma incisión, laparoscopia diagnóstica simultánea, y mejor resultado estético [1][2][3][4][5] . Más aún, debido a que trata la hernia en el lugar donde se produce, permite realizar una ligadura alta del saco peritoneal y colocar sin tensión una malla en el espacio preperitoneal.…”