A New Prosthetic Implant for Inguinal Hernia Repair: Its Features in a Porcine Experimental Model

Even after more than 100 years of inguinalhernia repair, the rate of complications and recurrenceremains unacceptably high. In the last decades, few effectiveadvances in surgical technique and materials have beenmade. The authors see them as minor adjustments in theshape and materials of the prosthetic implants. Still, theunderlying genesis of inguinal hernia remains undefined.Based upon this, it seems the surgical repair of inguinalprotrusions cannot be based upon the pathogenesisbecause the etiology to date has not been addressed. Mosthernia repairs are performed with some degree of pointfixation (sutures/tacks) to stop the mesh from migratingand creating high recurrence rates.This should be a priorityfor our considerations, as fixating mesh puts it in starkcontrast to the physiology and dynamics of the myotendinealstructures of the groin. Following years of surgicalpractice, implant fixation, mesh shrinkage, and poor qualityof tissue ingrowth still represent an unresolved issue inmodern hernia repair. Conventional prosthetics used foringuinal hernia repair are static and passive. They do notmove in harmony with the dynamic elements of the groinstructure and, as a result, induce the ingrowth of thin scarplates or shrinking regressive tissue that colonizes theimplants.The authors strongly believe that these characteristicsmay be a contributing factor for recurrences andpatient discomfort. Other complications are reported in theliterature to be a direct result of fixation of the implants,such as bleeding, nerve entrapment, hematoma, pain, discomfort,and testicular complications.To improve results byrespecting the physiology and kinetics of the inguinalregion, we felt that a new type of prosthesis should bedesigned that induces a more structured tissue ingrowthsimilar to the natural biologic components of theabdominal wall. This prosthetic device was specificallydesigned to be placed with no point fixation. This wasachieved by using inherent radial recoil, vertical buffering,friction, and delivering the device in a constrained state.Asecondary benefit of this “dynamic” design is that theimplant moves in a three-dimensional way in unisonwith the movements of the myotendineal structures ofthe groin. The results appear to show that the threedimensionalstructure not only acts as a suitable scaffold fora full thickness ingrowth of a tissue barrier but also seemsto induce an ordered, supple, elastic tissue,which allows forneorevascularization and neoneural growth.The outcomesindicate a reduced impact of fibrotic shrinkage on theimplant/scar tissue when compared with shrinkage ofpolypropylene meshes reported in the literature. This pilotstudy shows the features of such an implant in a porcineexperimental model.