Fixation-free inguinal hernia repair using a dynamic self-retaining implant.

Abstract

Inguinal hernia repair remains controversial, despite advances in technique and materials. Conventional implants are typically static (passive) and do not move in concert with the groin's motility. Inguinal hernia repair with mesh fixation on dynamic groin structures are not tension free, and are associated with tissue tearing, bleeding, hematoma, and nerve entrapment--all which might contribute to mesh dislocation. The poor quality of tissue ingrowth within static meshes/plugs embodies another crucial issue in prosthetic hernia repair. Because the prosthetics used for inguinal hernia repair are incorporated by rigid fibrotic tissue (hence the term "scar plate"), the regressive tissue leads to shrinkage and reduction of the mesh surface area--a significant cause of recurrence and discomfort. To improve inguinal hernia repair, a new 3D dynamic (inherent recoil), self-retaining implant has been developed. It achieved excellent outcomes in the porcine model, and demonstrated that the dynamic compliant movement and recoil of the 3D prosthetic structure within the groin's natural tissues allowed for the critical cyclical physiologic loading that is missing with other implants. Because enhanced biologic response and improved quality of tissue ingrowth result from its dynamic interactions with groin tissue, the shrinkage of the implant is nearly absent, even after long-term implantation. We discuss this dynamic hernia repair concept in this report. The use of this new 3D implant represented a faster and simpler surgical approach to inguinal hernia repair. The procedure was based on the centrifugal expansion of the device, whose design features converted ejection forces into gripping forces, and avoided the need for suturing the implant (eliminating a cause of complications related to prosthesis fixation).