How to do inguinal hernioplasty How to do inguinal hernioplasty with PROLENE Hernia with PROLENE Hernia

System(PHS)System(PHS)

溫義輝 奇美醫學中心 溫義輝 奇美醫學中心 Yih-Huei Uen, MDYih-Huei Uen, MD

Division of General Surgery, Department of Division of General Surgery, Department of Surgery, Chi Mei Foundation Medical Center, Surgery, Chi Mei Foundation Medical Center,

Tainan, Taiwan, ROC.Tainan, Taiwan, ROC.

Two important steps to sucessful Two important steps to sucessful preperitoneal hernia repair through preperitoneal hernia repair through

anterior approachanterior approach

Adequate Adequate actualization of actualization of preperitoneal pocketpreperitoneal pocket

Maximal deployment Maximal deployment of underlay graftof underlay graft

Key proceduress of preperitoneal dissectionKey proceduress of preperitoneal dissection

High dissection of hernia sacHigh dissection of hernia sac Correct entrance into preperitoneal spaceCorrect entrance into preperitoneal space Meticulous detachment of visceral sac from Meticulous detachment of visceral sac from

femoral vessels, vas deference and femoral vessels, vas deference and spermatic vessels(counter-traction with spermatic vessels(counter-traction with surgical gauze, Trendelenburg position)surgical gauze, Trendelenburg position)

American Surgeon 2007 May, Yih-Huei UenAmerican Surgeon 2007 May, Yih-Huei Uen 通過專利審核通過專利審核

An improved method for deploying An improved method for deploying the polypropylene underlay patch of the polypropylene underlay patch of

the the PROLENPROLEN Hernia SystemHernia System

Fig. 1: The procedures of development of a modified Fig. 1: The procedures of development of a modified

device of PHS.device of PHS.

Fig. 2: The procedures of intra-pocket manipulationFig. 2: The procedures of intra-pocket manipulation

Discussion IDiscussion I

Successful dissection of preperitoneal pocket Successful dissection of preperitoneal pocket – 1.coutertraction 1.coutertraction – 2.knowledge of anatomy 2.knowledge of anatomy – 3.gauge application 3.gauge application

Discussion IIDiscussion II

Advantage of modified PHSAdvantage of modified PHS– 1.underlay pocket graft with pressure resistance 1.underlay pocket graft with pressure resistance

perimeter perimeter – 2.fixation underlay graft to fascial edge :2.fixation underlay graft to fascial edge :

» ￬ ￬ onlay fixation onlay fixation pain pain

» Coutertract to deployment force Coutertract to deployment force

– 3.use of the end angled pusher 3.use of the end angled pusher the ease of intra-pocket manipulationthe ease of intra-pocket manipulation

» self check the deployment result self check the deployment result

ConclusionConclusion

1.Dissection of preperitoneal space should 1.Dissection of preperitoneal space should be undertaken throughlybe undertaken throughly

2.modified design and technique of PHS is 2.modified design and technique of PHS is a useful tool to improve the deployment of a useful tool to improve the deployment of underlay graft of PHS underlay graft of PHS