Abstract
Successful inguinal hernia repair requires reduction of the hernia contents and prevention of recurrence herniation by blockage of the myopectineal orifice. An appreciation of the anatomy of the region is necessary for performing the optimal procedure. Because of the complexity of the anatomy and the variable skill of surgeons, there have been many different hernia repair techniques described, seeking the ideal procedure. In 1997, Dr. Arthur Gilbert designed the Prolene Hernia System (PHS), a bilayer polypropylene mesh device with a flat underlay and overlay joined by a central connector. The product is suitable for all groin hernia repairs giving immediate strength and excellent long-term outcomes, with less than ½% recurrence rate, few complications, and minimal chronic pain. The procedure can be done as an outpatient under local anesthesia with sedation.
The low failure rate of the PHS device is due to complete coverage of the MPO by the underlay from behind and the overlay on the outside. The results for repairs done by all general surgeons using PHS are comparable to those of experts. Furthermore, the incidence of post-op pain is equal to or less than with other suture and mesh techniques. Surgeons should become familiar with and master different hernia techniques which they can select according to the needs of the individual patient. With its high success rate and ease of use for all surgeons, the Gilbert PHS procedure will remain an important hernia repair technique in the armamentarium of future generations of surgeons.
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References
Fruchaud H. Textbook: anatomie chirurgicale des hernies de l'aine. Paris: Doin; 1956.
Gilbert AI. The lateral triangle of the groin. Hernia. 2000;4:234–7.
Alexandre JH. The story of EHS-GREPA 1979–2014. Hernia. 2015;19:349–54.
Gilbert AI, Graham MF, Voigt WJ. A bilayer patch device for inguinal hernia repair. Hernia. 1999;3:161–6.
Bassini E. Sulla cura radicale dell’ernia inguinale. Arch Soc Ital Chir. 1887;4:380.
Bendavid R. The Shouldice repair. In: Fitzgibbons RJ, Greenburg G, editors. Hernia. 5th ed. Philadelphia: JB Lippincott; 2009. p. 129–38.
Cunningham J. Cooperative hernia sturdy: pain in the postrepair patient. Ann Surg. 1996;224:598–602.
Usher F, Fries J, Oschner JL. Clinical studies. Arch Surg. 1959;78:138–45.
Lichtenstein IL, Shulman AG. Ambulatory outpatient hernia surgery. Including a new concept, introducing tension-free repair. Int Surg. 1986;71(1):1–4.
Campanelli G, Pascual MH, Hoeferlin A, et al. Randomized, controlled, blinded trial of Tisseel/Tissucol for mesh fixation in patients undergoing Lichtenstein technique for primary inguinal hernia repair: results of the TIMELI trial. Ann Surg. 2012;255(4):650–7.
Rönkä K, Vironen J, Kössi J, et al. Randomized multicenter trial comparing glue fixation, self-gripping mesh, and suture fixation of mesh in Lichtenstein hernia repair (FinnMesh study). Ann Surg. 2015;262(5):714–9; discussion 719–20.
Stoppa RE. The midline preperitoneal approach and prosthetic repair of groin hernias. In: Fitzgibbons Jr RJ, Greenburg AG, editors. Nyhus and Condon’s hernia. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2002. p. 199.
Gilbert AI. Sutureless repair of inguinal hernia. Am J Surg. 1989;157:331–5.
Rosenberg J, Andresen K. Onstep—open new simplified totally extraperitoneal technique for inguinal hernia repair. In: Campanelli G, editor. Inguinal hernia surgery. New York, NY: Springer; 2016.
Young J, Gilbert AI, Graham MF. The use of ultrasound in the diagnosis of abdominal wall hernias. Hernia. 2007;11:347–51.
Gilbert AI, Young J, Graham MF. Combined anterior and posterior inguinal hernia repair: intermediate recurrence rates with three groups of surgeons. Hernia. 2004;8(3):203–7.
Poobalan AS, Bruce J, Smith WC, et al. A review of chronic pain after inguinal herniorrhaphy. Clin J Pain. 2003;19:48.
Alfieri S, Amid PK, Campanelli G, et al. International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery. Hernia. 2011;15(3):239–49.
Fitzgibbons R, et al. Watchful waiting vs repair of inguinal hernia in minimally symptomatic men—a randomized clinical trial. JAMA. 2006;295(3):285–92.
Kingsnorth A, Wright D, Porter CS, et al. Prolene Hernia System compared with Lichtenstein patch: a randomised double blind study of short-term and medium-term outcomes in primary inguinal hernia repair. Hernia. 2002;6:113–9.
Gilbert A, Graham M, Young J, et al. Closer to an ideal solution for inguinal hernia repair: comparison between general surgeons and hernia specialists. Hernia. 2006;10:162–8.
Miserez M, Peeters E, Aufenacker T, et al. Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2014;18(2):151–63.
Cox TC, Heniford BT, et al. International, prospective comparison of open inguinal hernia repair techniques: two-year quality of life (QOL) and recurrence outcomes in more than 1300 patients. JACS. 2015;4:S72.
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Young, J., Gilbert, A.I. (2018). Gilbert Technique: PHS Bilayer Repair. In: Campanelli, G. (eds) The Art of Hernia Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-72626-7_29
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DOI: https://doi.org/10.1007/978-3-319-72626-7_29
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