Comparative Laparoscopic Evaluation of the PROLENE Polypropylene Hernia Systemvs. the PerFix®Plug Repair in a Porcine Groin Hernia Repair Model

Abstract

Both the PROLENE Polypropylene Hernia System (Ethicon, Johnson & Johnson, Cincinnati, OH) and plug-and-patch devices including the Bard PerFix Plug repair (C.R. Bard. Inc., Murray Hill, NJ) are currently used in open groin herniorrhaphy. These systems rely on incorporating two mesh prostheses of different designs. In this animal study, early results for the two types of device were compared laparoscopically. Twenty-four uncastrated male pigs (average weight, 25 kg) were randomized into two groups of 12 each for repair of unilateral groin hernia defects with the PROLENE Hernia System (Prolene) or the PerFix Plug (PerFix). Laparoscopic examination was performed immediately after the surgery to check the configuration and coverage area of the preperitoneally positioned mesh devices, with stress-loading tests to compare their primary efficiency. By contrast to the PerFix prostheses, in which the preperitoneal cone-shaped mesh only obliterated the primary fascial defect, in two-thirds of the Prolene repairs the flat and widely deployed underlay patch not only overlapped the defect but also covered the entire myopectineal orifice. Under heavy stress loading (25 newtons), the Prolene group also had a significantly lower incidence of fascial defect exposure in comparison to the PerFix counterparts (P = 0.003). In the stress-loading tests, four Prolene and eight PerFix plugs failed (P >0.005), mainly due to tissue disruption. Properly implanted Prolene devices have a wider coverage area and lower risk of fascial defect exposure and thus should be the treatment of choice for large groin hernia defects where the inguinal floor is attenuated. Where the PerFix devices are used under these conditions, they must be adequately secured to a healthy fascial edge, with onlay coverage patches to eliminate any weak points that might cause early recurrence.