经腹壁行腹膜前鼠蹊疝气修补术课件_1.pptVIP

Anterior pre-peritoneal inguinal hernioplasty 經腹壁行腹膜前鼠蹊疝氣修補術 溫義輝 奇美醫學中心 Yih-Huei Uen, MDDivision of General Surgery, Department of Surgery, Chi Mei Foundation Medical Center, Tainan, Taiwan, ROC. Design(I) Modified device /technique of PHS: An improved method for deploying the polypropylene underlay patch of the PROLEN Hernia System: American Surgeon 2007 May, Yih-Huei Uen 通過專利審核 Fig. 1: The procedures of development of a modified device of PHS. Fig. 2: The procedures of intra-pocket manipulation Table 1. Results Comparative Laparoscopic Evaluation of the “ Original” versus “ Modified” Design of PROLENE Hernia System in A Porcine-groin Hernia-Repair Model Material and Method 30 uncastracted male pig (average BW: 24Kg) Unilateral anterior inguinal hernioplasty Group Original PHS(n=10) Modified PHS with onlay fixation (n=10) Modified PHS without onlay fixation (n=10) Hand–assisted laparoscopic stress-loading test using dynamometer Result (I) :The laparoscopy of the preperitoneally positioned mesh prosthesis§ Result (II): Comparsion of the results of stress-loading test Discussion ( I ): Special design and unique technique of “Modified” PHS Harboring a deploying underlay “pocket” graft with a pressure reception perimeter Fixating underlay graft to the fascial edge Using a narrow angled metal pusher to perform intra-pocket manipulation Full deployment of underlay graft against the inner surface of the inguinal floor to cover entire MPO (Pascal’s principle) Secure obliteration of fascial defect Increased stability of devices Self assessment of the adequacy of deployment Discussion ( II ):Potential advantage of “Modified” PHS prosthesis Discussion ( III ):  The fixation stitches of onlay patch traditionally used in “Original” PHS can be substituted by those of fascial edge in “Modified”device if it is strong enough. Can post-operative pain be decreased? Discussion ( IV ): Hand-assisted laparoscopic stress-loading test with dynamometer: Firstly used in asse