title: Incisional, epigastric and umbilical hernia repair using the Prolene Hernia System: describing a novel technique.
abstract: The Prolene Hernia System (PHS) is already widely in use in the United Kingdom for inguinal hernias. We describe the novel technique of using the three-in-one design of the PHS (Ethicon Endo-Surgery, Bracknell, UK) for repairing incisional, epigastric and umbilical herniae. This is a three-dimensional device and consists of an onlay patch, a tubular connector and an underlay patch. We recommend a four 'corner' suturing of the underlay patch under vision (and then) through the full thickness of abdominal wall layers to ensure a flat underlay mesh. These four sutures flatten out the underlay patch and can be tied or removed with equal effect. The sutures are placed at 3, 6, 9 and 12 o'clock, which simplifies the procedure and ensures that the underlay lays correctly and is corrugation-free and tension-free, thereby providing a two-layer repair for those herniae with a high rate of recurrence.
authors.affiliation: Arrowe Park Hospital, Wirral Hospital NHS Trust, Arrowe Park Road, Upton, Wirral CH49 5PE, UK. goldiekhera@yahoo.com
authors.forename: Goldie
authors.initials: G
authors.lastname: Khera
authors.forename: David A
authors.initials: DA
authors.lastname: Berstock
mesh_terms: D046449:Hernia, Abdominal / Q000601:surgery*; D006554:Hernia, Umbilical / Q000601:surgery*; D006801:Humans; D013523:Surgical Equipment