Use of Light Weight, Partially Absorbable Mesh in Open Inguinal Hernia Repair: One Year Prospective Data with the Cousin 4ddome™

Florias A Morfesis, MD, Brian P Rose, BSc. Owen Drive Surgical Clinic of Fayetteville/East Carolina University

Introduction: Over the past 24 months, we have cataloged 80 open inguinal hernia repairs using the Cousin 4DDOME. Since May 2009, we have documented the pre-operative and post-operative pain of patients repaired using this product based on the simple hypothesis that less inflammatory response elicited by the prosthetic equals less pain. To access the efficiency of the repair, we used post-operative pain as an indicator for recurrence and rejection.

Study Design: Patients were given our pain scale which was a hybrid between the Carolinas Comfort Scale (CCS) and SF-36 Quality of Life Scale. This scale was newly originated by our group. Each patient since May 2009 has received a survey at their pre-op consult and fixed interval post-operative times.

Results: Over the last 24 months, we have recorded no evidence of hernia recurrence any patient (n=72). Patients given a survey pre-op showed a wide array of responses on a scale 0 to 59. Based upon their specific number score, we were then able to place patients into risk categories based upon the debility and pain they felt before repair as an accurate predictor of post-operative pain and potential complications. In our test group, 8 out of 46 (17%) patients given the hernia survey reported a pre-op survey of greater than 30 putting them in the high risk category. At one month post-repair, only 2 patients (4%) reported a pain score greater that 30 demonstrating a significant improvement in the other six. One patient required post-operative neural injection and a subsequent pain management consultation.

Conclusion: The use of light weight, partially absorbable mesh in hernia repair has recently found itself in competition with other materials which we believe cause more inflammation and thus more pain. The unique biochemical composition of the 4DDOME allows for simplistic integration at repair, followed by long term durability without heavy scarring. Based upon our definitive results, the Cousin 4DDOME is a safe and effective product to be used in open inguinal hernia repair in even the most high risk of patients.