1. Preperitoneal inguinal hernioplasty with ULTRAPRO versus PROLENE mesh Chei Mei medical center Uen Yih-huei

2. Introduction (I) 1. PROLENE Hernia System (PHS) has been developed to improve the result of hernioplasty. However, it is difficult to definitely deploy PHS's underlay patch with surgical methods Underlay patch Onlay patch

3. 2. Underlay "pocket" graft of modified PHS has been developed to facilitate it's deployment ( U Y-H Am surgeon 2007 ) underlay "pocket“ graft PHS additional patch

4. 3.Theorectically, if the underlay graft can be fully deployed to cover entire MPO, there is no need of onlay patch and connector device underlay "pocket“ graft PHS additional patch

5. Introduction (II) 1.The underlay graft has been newly made by ULTRAPRO mesh 2.ULTRAPRO mesh has been claimed to be not only partially absorbable resulting less amount of mesh volume but also strong enough to overcome the greatest abdominal pressure during coughing

6. Aim 1.To assess the adequacy of underlay "pocket" graft in preperitoneal hernioplasty 2.To compare the effectiveness of ULTRAPRO(U) mesh versus PROLENE(P) mesh in hernioplasty

7. Material and Methods (I) 1. From June 1 2005 till Dec 31 2006, totally 81 patients with unilateral primary inguinal hernia undergoing preperitoneal hernioplasty (through anterior approach) with underlay "pocket" graft(10 cm in diameter), were randomized into two groups: A.PROLENE group(40 Pts) with inner layer of P mesh and outer layer of U mesh B.ULTRAPRO group(41 Pts) with both inner and outer layers of U mesh outer layer: U mesh inner layer : P mesh PROLENE group

8. Material and Methods (II) 2.Prophylatic antibiotics: Cephazoline I gm IV preop 3.Regular OPD FU Q6 months ( at least 2 years )

9. Surgical methods 1.Preperitoneal dissection 2.Insertion of the underlay graft into pre-peritoneal space 3.Deployment of the underlay graft with instrumental and digital manipulation 4.Fixation of the graft on fascial defect edge

10. Table (I) Patient characteristics ＊ PROLENE group (n=40) ULTRAPRO group (n=41) Age (year)32 ± 431 ± 5 Sex (M / F)38 / 239 / 2 Hernia type Indirect 2021 Direct 19 Femoral 11 FU duration (month)30 ± 631 ± 5 ＊ Insignificant difference between both groups

11. Table (II) Results 0 1 0 0 0 1 38.7 ± 5.3 44.3 ± 3.9 ULTRAPRO group ( N = 41 ) 0 Post OP recurrence *Student’s t test **Chi-square test 0 Wound infection 1 Wound hematoma 0 Intestinal obstruction 1 Hydrocele >0.052Morbidity** >0.0537.6 ± 4.7 Direct hernioplasty >0.0543.2 ± 5.7 Indirect hernioplasty OP time (mean ± SD)* P value PROLENE group ( N = 40 )

12. Discussion (I) Summary of the results of present study: 1.Underlay "pocket" graft without onlay patch or connector device is adequate for preperitoneal hernioplasty 2.ULTRAPRO mesh is as efficient as PROLENE mesh in inguinal hernioplasty

13. Discussion (II) Problems encountered during anterior preperitoneal hernioplasty A.Adequate preperitoneal dissection B.Full deployment of mesh prosthesis C.Immobilization of mesh prosthesis D.Proper mesh strength E.Minimal mesh volume ( All but the first one can be successfully settled by ULTRAPRO underlay "pocket" graft ! )

14. Further studies The role of ULTRAPRO underlay “pocket” graft in recurrent inguinal hernia should be further delineated Comparison of the operative results and quality of life between underlay “pocket” graft and laparoscopic hernioplasty using ULTRAPRO mesh

15. Conclusion The ULTRAPRO underlay "pocket" graft used in this study is an useful alternative for preperitoneal inguinal hernioplasty with favorable clinical results and no increase amount of foreign body.

16. Thanks for your attention!!