Ultrapro Hernia System

Bi Layer
Dr Cosmas Gora T SpB-KBD

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 Why UHS?
• Lightweight Mesh
• Covering entire myopectineal orifices with
underlay mesh in preperitoneal space (posterior
repair)
• Covering the inguinal floor with onlay mesh
(Lichtenstein’s)
• Technique
 Ultrapro Hernia System
• UHS is a partially
absorbable, three-
dimensional lightweight
mesh

• Combines the best features

of the three most popular
repairs:
-Underlay patch (lap.
repair)
-Onlay patch (Lichtenstein)
-Connector (Plug)
 Ultrapro Hernia System
• The onlay patch, connector
and underlay patch are
manufactured from
approximately equal parts of
absorbable MONOCRYL
fiber and non-absorbable
PROLENE fiber. The
underlay patch is reinforced
by a flat, undyed absorbable
film of MONOCRYL.
UHS in the Posterior Space
 Six Steps for Placing
Bi-Layer Hernia System

Step One

Develop the anterior

pocket under the
external oblique to
optimize placement of
the onlay patch.
Dissect out laterally to
ensure the onlay patch
will lie flat.
 Six Steps for Placing
Bi-Layer Hernia System

Step Two
After the posterior wall has
been opened, visually
confirm that you are in the
preperitoneal space by
identifying the “yellow”
preperitoneal fat and by
visualizing Cooper’s
ligament.

Step Three
Then, using the forefinger,
sweep circumferentially
medial, then lateral to
actualize the preperitoneal
space.
 Six Steps for Placing
Bi-Layer Hernia System

Step Four
Having grasped the onlay
patch down to the connector
with sponge forceps…

Step Five
Insert device completely
into the defect and deploy
underlay with forceps or
finger
 Six Steps for Placing
Bi-Layer Hernia System

Step Six
Suture fixate the onlay patch:
1) Over the pubic tubercle
(essential)
2) To the mid-portion of the
transverse aponeurotic arch
(optional).

Create a slit in the onlay patch

to accommodate the
spermatic
cord. Suture the mesh to
close the slit.
 Ultrapro Hernia System
• Incision along lower abdominal skin crease
 Ultrapro Hernia System

• Incision along
Aponeurosis of EOM.

• Bluntly create a space

under this layer.
 Ultrapro Hernia System

• Spermatic cord is
isolated and encircled.
 Ultrapro Hernia System
• Indirect Hernia sac is isolated
 Ultrapro Hernia System

• Handling the hernia sac:

-High ligation and excision

or

-Reduction into preperitoneal space

 Ultrapro Hernia System
• Through the hernia defect, preperitoneal space is
created, first with a piece of gauze.
 Ultrapro Hernia System
• And then, gentle blunt dissection using finger.
 Ultrapro Hernia System
• In Direct Inguinal Hernia, an incision is made at the
transversalis fascia, over the defect, to access
preperitoneal space.
 Ultrapro Hernia System
• Align the onlay patch along the direction of inguinal
canal.
 Ultrapro Hernia System
• Fold the onlay patch and grasp with sponge forceps.
 Ultrapro Hernia System
• Deploy the underlay patch into the preperitoneal space
and spread to cover the MPO.
 Ultrapro Hernia System
• Spread the onlay mesh
 Ultrapro Hernia System
• Make a slit in onlay patch to accommodate the spermatic
cord.
 Ultrapro Hernia System
• Place the onlay patch to cover the inguinal floor medially,
and to encircle the spermatic cord laterally.
 Ultrapro Hernia System
• Overlapping the two tales of the onlay patch to close the
slit
 Ultrapro Hernia System
• A Vicryl suture is placed to close the slit.
 Ultrapro Hernia System
• Another Vicryl suture is placed on anchor the onlay patch
to the pubic tubercle.
 Ultrapro Hernia System
• Aponeurosis of EOM is closed over the spermatic cord,
with a continuous Vicryl suture.
 Ideal Hernia Repair
• Minimal Recurrent Rate
• Minimal Complication, especially chronic pain.
• Short Learning Curve with Reproducible Results
Comparison of open technique

Benjamin Woods, Surg Clin N Am 88 (2008) 144

 “Recent randomised research has shown that
the Shouldice technique is considerably better
than the non original Bassini technique and the
Marcy technique (simple narrowing of the
internal ring) with recurrence percentages in the
long term of 15, 33 and 34%, respectively. The
Bassini technique and Marcy’s technique are,
therefore, obsolete.”
 Boheiden Experience
• This new bilayer device answers the need for
complete protection of the myopectineal orifice
and allows us to anticipate a lower recurrence rate
than other popular techniques, and with low
patient discomfort due to its lightweight
 Bilayer Mesh Repair: Conclusion
• Minimal Recurrent Rate
• Minimal Complication, especially chronic pain.
• Short Learning Curve with Reproducible Results
THANK YOU
A surgeon can do more for the community by
operating
on hernia cases and seeing that his recurrence rate
is low than he can by operating on cases of
malignant
disease.

—Sir Cecil Wakely, 1948

President
Royal College of Surgeons