The clinical trial of the ideal mesh placement for the laparoscopic inguinal hernia repair with the elasticated mesh

Hideto Oishi, MD, Fumi Maeda, MD, Takeshi Ishita, MD, Masayuki Ishii, MD, Takuya Satou, MD, Takayuki Iino, MD, Hidekazu Kuramuchi, MD, Shunsuke Onizawa, MD, Eiichi Hirai, MD, Mie Hamano, MD, Tutomu Nakamura, MD, Tatsuo Araida, MD. Yachiyo Medical Center, Tokyo Women’s Medical University.

Introduction: The existing mesh (wired mesh, pre-shaped mesh, etc.) for inguinal hernia causes continuous discomfort at times, due to forcible adaptation. The mesh placement for the surface of an inguinal area is one of the important points for this surgery. However depending on an individual difference, the existing mesh might not be the best fitting to surgical surface. To get more closely, fitting to inguinal surgical surface of laparoscopic hernia repair, we used elasticated flat-mesh, ULTRAPRO. This mesh could be lengthened unidirectionally. This elasticated function was able to fit closely to cover the surgical surface, and examined the difference in effect by its different lengthen-able direction.

Materials and methods: For two external inguinal hernia cases, we performed trans extraperitoneal hernia repair (TEP) with two different types of elasticated flat-mesh, ULTRAPRO. One was UMN3 (10cmX15cm), and the other was UMM3 (15cmX15cm). These two meshes had a few blue horizontal stripes, and has lengthen-able direction perpendicular to the horizontal stripe. With a proviso that the elasticized direction of the mesh was rotated 90 degrees, UMM3 (15cmX15cm) was resized as a same sized mesh to UMN3 (10cmX15cm). Therefore the resized UMM3 (10cmX15cm) had vertical stripes. And as a control test, polypropylene flat-mesh, PROLENE Soft (7.6cmX15cm), was used to another case, and this mesh did not have elasticated function. Sites of tacking for each mesh were done at the almost same place by the same tacking device, AbsorbaTack.

Result: The standard TEP procedure was performed for these three cases without complication. By placing the non-elasticated mesh, PROLENE Soft (7.6cmX15cm), some excess spaces were left between mesh and surgical surface. When using the elasticated mesh, ULTRAPRO UMN3 (10cmX15cm), vertical shrinkages and horizontal creases were made on the mesh. However, placing the resized elasticated mesh, ULTRAPRO UMM3 (10cmX15cm), was stretched horizontally to cover the lump caused by ileac artery and it gave smooth mesh fitting to surgical surface.

Discussion: There are already many kinds of mesh for inguinal hernia repair, however existing mesh might not give the best fitting to surgical surface depending on an individual difference. Especially unique shaped mesh doesn’t necessarily give the best adaptation. The unique shaped mesh might not only give forcible adaptation, but also they might get creases and/or deform. The flat mesh has good flexibility to fit to surgical surface.

Conclusion: By getting lateral elasticized function, the flat mesh will provide the best fitting to the surgical surface.

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