Il trattamento dell'ernia inguinale con il Prolene Hernia System (PHS)

Among the several techniques available for the treatment of inguinal hernia, the Prolene Hernia System (P.H.S.) has gained widespread acceptance over the past few years. This is an original prosthetic device that combines, in a single step, what other techniques offer separately, namely an underlay patch (preperitoneal placement), an onlay patch (subfascial placement) and a connector that joins them together and works as a plug. The aims of this study were to specify the indications and the technique of this method and to evaluate its efficacy in our experience. From January 1999 to July 2003 we performed 156 inguinal herniorraphies with the P.H.S. in 152 patients (143 male, 9 female; mean age 62.4 years). One hundred and thirty-six cases were primary hermias (mainly types III, IV and VI according to the Rutkow and Robbins classification) and 18 were recurrences (mainly type R3 according to the Campanelli classification). In 56.5% of cases the operations were performed in the day surgery setting, 37.5% as ordinary admissions and 6% as emergency procedures. Locoregional (62.5%) or local (34.2%) anaesthesia were mainly given. Early postoperative complications (7%) were 7 haematomas and 4 seromas. In 125 patients with a follow-up of at least 6 months, the late postoperative complications included 4 cases of persistent inguinocrural pain among the primary hernias (3.7%) and a new recurrence among the recurring hernias. The Authors believe that hernia repair with the P.H.S. is a valid choice comparable to the other common techniques but they suggest its use particularly in primary hernias with major relaxation of the posterior inguinal wall of the inguinal canal or of the entire myopectineal orifice