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Why UHS? Lightweight Mesh Covering entire myopectineal orifices with underlay mesh in preperitoneal space (posterior repair) Covering the inguinal floor with onlay mesh (Lichtenstein s) Technique
UHS is a partially absorbable, threedimensional lightweight mesh Combines the best features of the three most popular repairs: -Underlay patch (lap. repair) -Onlay patch (Lichtenstein) -Connector (Plug)
The onlay patch, connector and underlay patch are manufactured from approximately equal parts of absorbable MONOCRYL fiber and non-absorbable PROLENE fiber. The underlay patch is reinforced by a flat, undyed absorbable film of MONOCRYL.
UHS in the Posterior Space
Six Steps for Placing Bi-Layer Hernia System Step One Develop the anterior pocket under the external oblique to optimize placement of the onlay patch. Dissect out laterally to ensure the onlay patch will lie flat.
Six Steps for Placing Bi-Layer Hernia System Step Two After the posterior wall has been opened, visually confirm that you are in the preperitoneal space by identifying the yellow preperitoneal fat and by visualizing Cooper s ligament. Step Three Then, using the forefinger, sweep circumferentially medial, then lateral to actualize the preperitoneal space.
Six Steps for Placing Bi-Layer Hernia System Step Four Having grasped the onlay patch down to the connector with sponge forceps Step Five Insert device completely into the defect and deploy underlay with forceps or finger
Six Steps for Placing Bi-Layer Hernia System Step Six Suture fixate the onlay patch: 1) Over the pubic tubercle (essential) 2) To the mid-portion of the transverse aponeurotic arch (optional). Create a slit in the onlay patch to accommodate the spermatic cord. Suture the mesh to close the slit.
Incision along lower abdominal skin crease
Incision along Aponeurosis of EOM. Bluntly create a space under this layer.
Spermatic cord is isolated and encircled.
Indirect Hernia sac is isolated
Handling the hernia sac: -High ligation and excision or -Reduction into preperitoneal space
Through the hernia defect, preperitoneal space is created, first with a piece of gauze.
And then, gentle blunt dissection using finger.
In Direct Inguinal Hernia, an incision is made at the transversalis fascia, over the defect, to access preperitoneal space.
Align the onlay patch along the direction of inguinal canal.
Fold the onlay patch and grasp with sponge forceps.
Deploy the underlay patch into the preperitoneal space and spread to cover the MPO.
Spread the onlay mesh
Make a slit in onlay patch to accommodate the spermatic cord.
Place the onlay patch to cover the inguinal floor medially, and to encircle the spermatic cord laterally.
Overlapping the two tales of the onlay patch to close the slit
A Vicryl suture is placed to close the slit.
Another Vicryl suture is placed on anchor the onlay patch to the pubic tubercle.
Aponeurosis of EOM is closed over the spermatic cord, with a continuous Vicryl suture.
Ideal Hernia Repair Minimal Recurrent Rate Minimal Complication, especially chronic pain. Short Learning Curve with Reproducible Results
Comparison of open technique Benjamin Woods, Surg Clin N Am 88 (2008) 144
Recent randomised research has shown that the Shouldice technique is considerably better than the non original Bassini technique and the Marcy technique (simple narrowing of the internal ring) with recurrence percentages in the long term of 15, 33 and 34%, respectively. The Bassini technique and Marcy s technique are, therefore, obsolete.
Boheiden Experience This new bilayer device answers the need for complete protection of the myopectineal orifice and allows us to anticipate a lower recurrence rate than other popular techniques, and with low patient discomfort due to its lightweight
Bilayer Mesh Repair: Conclusion Minimal Recurrent Rate Minimal Complication, especially chronic pain. Short Learning Curve with Reproducible Results
THANK YOU A surgeon can do more for the community by operating on hernia cases and seeing that his recurrence rate is low than he can by operating on cases of malignant disease. Sir Cecil Wakely, 1948 President Royal College of Surgeons