Inguinal / Femoral Hernia Mesh
Surgical mesh for the repair of hernias was introduced over a century ago. The first generation of surgical mesh prosthetics were notorious for a variety of postsurgical complications including infections, recurrence, rejection of the mesh, and development of dense scar tissue. Today, more than 80% of hernia repairs use some form of surgical mesh to reinforce the defect in the abdominal wall.
Investigations and research for the ideal material that is stable, resistant to infection, maintains strength over time, incorporates itself into our natural tissue, is non-carcinogenic and restores natural function of the body wall has been vast, controversial and continues today. The overall success of implanted mesh depends on the primary material used, the structure of individual filaments, the size of the pores and the coating material. These characteristics of mesh are designed to reduce the foreign body reaction and promote successful integration and healing.
Multiple mesh categories exist, based upon their physical properties and how they interact with the patient’s body. The first mesh technologies consisted of synthetic permanent meshes that did not incorporate with the body, were associated with a high rate of extrusion and infection. As surgical mesh technology improved, the meshes became more sophisticated. Absorbable meshes, as well as “biologic” meshes were introduced that offered resistance to infection and were either degraded or incorporated into the body. Now, meshes are made from a large variety of materials and tailored to the needs of the specific hernia defects. This advanced approach has been made possible by the many technological advances that have been achieved.
Inguinal / Femoral Hernia Repair
Groin hernia management was first described in medical writings by the ancient Egyptians. Early repairs were attempted with little understanding of the complex anatomy in the groin region and were greatly unsuccessful. With increased understanding of anatomy and advancement of aseptic techniques and anesthetic principles, the management of groin hernias evolved.
Surgical repair now involves both the reduction of the herniated contents back into the abdomen, as well as tension-free correction and/or reinforcement of the defect in the abdominal wall. Many techniques exist for the repair of groin hernias, including: the Shouldice, the Bassini, the McVay, and the Lichtenstein repair.
The techniques mentioned above are considered open procedures, requiring an incision in the groin to access the hernia sac. Once the hernia contents are reduced, the defect in the body wall is either repaired by sewing it closed with suture (primary repair) or by covering it with mesh (patch repair).
Today, the leading technique for open inguinal hernia repair is the Lichtenstein procedure, a tension-free repair utilizing the placement of inguinal hernia mesh to correct the defect in the abdominal wall. Less invasive laparoscopic and robotic options also exist, and include the TEP (Totally Extraperitoneal) and TAPP (Transabdominal Preperitoneal) approaches.
Inguinal / Femoral Hernia
Hernias occur due to the protrusion of an organ or tissue through a defect or weak spot in the connective tissue of the body wall. The most common location of herniation is within the abdominal wall, particularly in the groin (inguinal region). In the groin, the majority of hernias occur through the inguinal canal, which can be classified as direct or indirect based on the location of the defect.
Femoral hernias are less common but also occur in the groin and can appear similar to inguinal hernias. Numerous classification systems exist for groin hernias; however, the majority of surgeons simply classify the hernia based on type, location and size.
Duatene bilayer mesh by Medtronic is a synthetic polypropylene mesh used in the open repair of groin hernias. The typical polypropylene hernia systems have a bridge, or connection between the two layers of mesh that fill the defect at the hernia site. This bridge does not typically include the same synthetic material of the mesh, whereas the Duatene bilayer mesh fills the bridge with the same synthetic polypropylene fibers included in the two mesh layers.
This technology may increase the strength of the mesh by enabling tissue integration directly within the groin defect. The two layers of the mesh, known as an onlay and underlay, are used to repair both sides of the abdominal wall, while the connector is situated within the opening of the defect. Advantages to Duatene include increased flexibility for ease of placement by the surgeon and anatomical conformability for the patient.