Initial Outcomes for Laparoscopic Inguinal Hernia Repair With Partially Absorbable Polypropylene/polyglecaprone-25 Mesh.

Edward Samourjian, MD, Shawn Tsuda, MD. University of Nevada School of Medicine Department of Surgery.

Introduction
This study reports the short-term outcomes for the use of a partially absorbable polypropylene/polyglecarpone-25 mesh (PhysiomeshTM, Ethicon, Cincinatti, OH) in laparoscopic total extraperitoneal (TEP) inguinal hernia repair. Physiomesh is a composite mesh composed of nonabsorbable polypropylene mesh laminated between two layers of polyglecaprone-25 film (monocryl). The purpose of the monocryl film is to prevent contact of the nonabsorbable polypropylene mesh with the intra-abdominal visceral contents during the initial phases of the inflammatory cascade. This is purported to aid in the reduction of adhesion to the mesh. However, tissue ingrowth begins forming following the initial phase. Physiomesh was launched for usage in August of 2010. In our institution, present initial outcomes using Physiomesh for TEP laparoscopic inguinal hernia repair.

Methods and Procedures
The 15×15 cm partially absorbable polypropylene/polyglecarpone-25 mesh was FDA approved for hernia repair in August 2010. Consecutive laparoscopic inguinal TEP repairs were performed between August 2010-August 2011 at a single institution and a retrospective analysis of records performed with IRB approval. The mesh was fashioned to 15×13 cm and a three port technique with a Stoppa-like repair was used to place the mesh, and two absorbable tacks in the Cooper’s ligament were used to secure it. Specific outcome measures investigated were recurrence, seroma/hematoma, small bowel infection, unplanned return to the OR, infection, and mortality. A student’s T-test was used to compare outcomes to published meta-analyses.

Results
Data collection included all cases from August 2010 until August 2011. A total of 68 inguinal hernias were repaired with TEP in 51 patients. Over the course of the data collection period, we did not observe any hernia recurrences, wound infections, reoperations, readmissions, bowel obstructions or deaths. Range of follow up was 2-16 weeks. We did observe 14/68 (20.5%) seromas post-operatively, none requiring intervention. This was non-significant compared to recent meta-analyses (11.9%, p=0.22%).

Conclusion
The use of a partially absorbable polypropylene/polyglecarpone-25 mesh in laparoscopic inguinal hernia repair is feasible with acceptable short-term outcomes. A partially absorbable mesh with a light-weight polypropylene component may be technically advantageous with handling and reduce foreign-body response. Long-term outcomes in a randomized setting may be required to establish efficacy.

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