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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