Early Experience with a New Anatomical Mesh for Endo-laparoscopic Inguinal Hernia Repair

Sujith I Wijerathne, MBBS, MRCS, Narendra Agarwal, MBBS, MS, Dino A Liem, MD, Davide Lomanto, MD, PhD, FAMS. Minimally Invasive Surgery Centre, Department of Surgery, National University Health System, Singapore.

Background and objective
Laparoscopic inguinal hernia repair has advanced over the past decade together with the development of new biomaterials to improve clinical outcome and patient care. The use of flat or anatomical mesh and the options for fixation has been a debatable topic where sufficient evidence for the best therapeutic option is not yet available. The concept of anatomical mesh is still new to the practice and the few available do not require fixation that may increase post-operative pain. Our objective was to verify the safety and feasibility of a new anatomic mesh with a unique multi-dimensional design, C-Qur CentriFX mesh is made by polypropylene and coated with Omega-3 to reduce inflammation. The mesh has unique peculiarity with its invertible design that standardizes the use in both right and left sided hernia.

Methodology
This is a prospective observational case series. C-Qur CentriFX mesh was used in 12 consecutive patients with inguinal hernia that underwent laparoscopic hernia repair. A standard 10.5 x 16cm size was used in all patients. Information on patient demographics, hernia description according to EHS classification, operative findings and technique, post-operative complications including pain scores and recurrence were recorded during post-operative period at 6, 12 hours and at discharge then during follow-up visits at 1 week, 1, 3 and 6 months. Visual Analogue Scale (VAS) was used to assess the pain.

Results
20 meshes were used in 4 unilateral and 8 bilateral inguinal hernia in 12 male patients with a mean age of 61 years. According to EHS classification the size and number of defects were L1=8, L2=5, L3=2, M1=2, M2=7, M3=4, F1=2 and R=2. Six patients had multiple fascial defects on at least one side. Standard 3 port totally extra-peritoneal (TEP) approach was used in 10 patients while single incision trans-abdominal pre-peritoneal (TAPP) approach was used in 2 patients. Mean operative time for unilateral hernia was 49mins (range 42 – 64mins) while in bilateral hernia it was 85mins (range 44-132 mins). 1 patient had a left scrotal hematoma and another patient presented with local peritonitis due to small-bowel perforation on post-operative day-3 and underwent emergency laparotomy for repair of perforation and mesh removal. Both patients subsequently recovered well. Post-operatively, mean VAS at 6hours was 0.75 (range 0-3), at 12hours 0.58 (range 0-2) and at discharge 0.17 (range 0-2). None of the patients reported pain during the follow-up visits. No recurrence was reported during the 6 months follow-up period.

Conclusion
Our early experience with the new anatomical mesh is similar and comparable to the other meshes available in the current practice, without the need for fixation. A longer follow-up may be required for further assessment of this mesh.

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