Dynamic Self-Regulating Prosthesis (Protesi Autoregolantesi Dinamica): The Long-Term Results in the Treatment of Primary Inguinal Hernias
GABRIELE VALENTI, M.D./ EMANUELE BALDASSARRE, M.D./ AEESSANDRO TESTA, M.D./ ALESSANDRO ARTURI, M.D./ GIOVANNI TORINO, M.D.,* COSTANTINO CAMPISI, M.D.,+ GIORGIO CAPUANO, M.D.*
From the “Department of General Surgery, San Pietro Hospital-Fatebenefratelli, Rome, Italy; and f National Research Council, Rome, Italy
The dynamic self-regulating prosthesis (protesi autoregolantesi dinamica, PAD) is a double- layered prosthesi, in use since 1992 in inguinal hernia repair. In 1999, we published the short-term results on 500 patients and herein we report the long-term follow-up.
Dynamic Self-Regulating Prosthesis
Five hundred eighty-five PAD procedures were performed on 500 adult male, unselected patients. Hernias were unilateral in 415 patients, were bilateral in 85 patients, were direct in 197 patients (33.7%), were indirect in 269 patients (46.0%), and were combined in 119 patients (20.3%).
Four hundred sixty-four patients were alive at the follow-up period of minimum 5 years, whereas 36 died (7.2%) of causes unrelated to the hernia. No information was available on 73 patients (14.6’%>). Therefore, the follow-up was consisted of 391 patients (78.2%) with 469 hernias. The recurrence and testicular atrophy rates were nil.
Three patients (0.77%) presented chronic pain and 18 (4.6%) suffered persistent discom- fort or paresthesia. A hydrocoele was observed in one patient (0.2%). The long-term data confirm the efficacy of the dynamic self-regulating posthesis hernioplasty. We propose it as a standard of care in all cases of primary inguinal hernia in adult males, retaining it as a definitive and comfortable solution.
THE DYNAMIC SELF-REGULATING prosthesis (PAD- Ethicon®) is a double-layered and cut-stamped prosthesis, single sized, used since 1992 to treat all primary adult male inguinal hernias.
The prosthesis was designed to combine the elimination of recur- rences, typical of Liechtenstein’s “tension-free” con- cept and the postoperative comfort of “sutureless” techniques, being careful not to expose the patient to late complications from the presence of prosthetic ma- terial. The PAD then represents a technical solution that sums up the last 30 years of experience in the hernia repair of our surgical department.
In 1999 we published the preliminary results of a group of 500 patients. The aim of this article is to review the long-term follow-up of those patients and to reconsider the original technique in the light of a 13-year experience with over 2000 patients treated.
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