WO1999056664A1 - Laparoscopic hernia repair - Google Patents
Laparoscopic hernia repair Download PDFInfo
- Publication number
- WO1999056664A1 WO1999056664A1 PCT/AU1999/000329 AU9900329W WO9956664A1 WO 1999056664 A1 WO1999056664 A1 WO 1999056664A1 AU 9900329 W AU9900329 W AU 9900329W WO 9956664 A1 WO9956664 A1 WO 9956664A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- tissue
- prosthetic
- members
- wall defect
- muscle wall
- Prior art date
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/0063—Implantable repair or support meshes, e.g. hernia meshes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/0057—Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/0063—Implantable repair or support meshes, e.g. hernia meshes
- A61F2002/0068—Implantable repair or support meshes, e.g. hernia meshes having a special mesh pattern
Definitions
- the present invention relates to a prosthetic device for use in the surgical repair of hernias and more particularly to a method for repairing medical afflictions such as hernias using the prosthetic device.
- Hernia repairs are one of the most commonly performed operations in western society. In the United States alone an estimated 600,000 to 700,000 hernia repairs are performed each year. Unfortunately, hernia repairs are also one of the more commonly repeated surgeries. Repairs are commonly needed where the initial repair does not reinforce the hernia or the repair breaks down because of additional strain in the locality of the hernia.
- the mesh is fashioned in the form of a patch that is placed over the hernia to provide reinforcement and support.
- patches are usually constructed as a single sheet and are held in place via staples, tacking device, or sutures.
- sutures are difficult to apply via laparoscopic surgery and there is a great likelihood that the repair will break due to failure to make the repair anatomical ie the mesh not providing protection in the potential weakness areas.
- the patch is formed as a rolled up sheet of surgical plastic mesh - 2 - that is maintained in a rolled up form by two bands. Longitudinal slits are formed in one of the ends of the rolled up mesh to form multiple flared out flaps to which a sheet of plastic surgical mesh is secured. The rolled up part of the patch is then inserted through the internal ring and the sheet is fixed in position with a tacking device.
- hernia repair patches While there are many different types of hernia repair patches that are available on the market, most are somewhat complicated and difficult to implant via laparoscopic surgery. Furthermore, most patches rely on fastening means such as a tacking device or staples to hold them in place.
- the present invention seeks to provide such a prosthetic together with a method for its use.
- the present invention resides in a biologically compatible prosthesis for repairing or reconstructing a tissue or muscle wall defect, comprising: a first member, a second member, and a holding member wherein:
- the holding member(s) is capable of being used for the purposes of (i) drawing at least a portion of the first and or second members through the tissue or muscle wall defect and (ii) fastening the prosthesis to the tissue under repair.
- the members in the prosthetic includes any material that is substantially flexible, is of a single layer in the locality where the members overlap and of a substantially single layer in the remaining regions.
- a material that is of a substantially single layer includes materials where about 50%, 60%, 70%, 80%, 85%, 90%, 95% 99% or most preferably 100% of the member is of a single layer of material which material is when laid flat.
- the material may contain one or more ribs to provide additional support to the member when located in situ in a patient.
- the material should be able to conform to the contours of muscle or tissue when positioned in situ. Most preferably the material exists in a flat state ex situ but due to its flexible properties is capable of being compressed.
- tissue or muscle wall defect includes any separation in the tissue or muscle that has lead to a interstice, hole or gap being formed in that tissue such as that which would be formed from a hernia or the like.
- first member and the second may each be separate unconnected members of the prosthetic, a person of ordinary skill in the field will appreciate that these members may also be connected together without departing from the spirit of the invention.
- the first and second members are joined via a bridging means formed of essentially the same material from which the members are constructed.
- the bridging means is preferably located in the general region where the members overlap when in use. Most preferably the bridging means engages the members in the same place where the holding means attaches to the members.
- the invention consists in a biologically compatible prosthesis for repairing or reconstructing a tissue or muscle wall defect, comprising: a first member, a second member, a bridging member and a holding member wherein:
- the holding member(s) is capable of being used for the purposes of (i) drawing at least a portion of the first and or second members and the bridging member partially through the tissue or muscle wall defect and (ii) fastening the prosthesis to the tissue under repair.
- the first member and the second member are connected via a bridging member which provides an attachment point for the holding member.
- the second member is folded over the first member.
- the second member is then folded back over the bridging member, therein forming three layers in the locality of the bridging member and two layers in the remaining locality where the first and second members overlap.
- the holding member can then be attached to the first member, the second member and the bridging member in the locality where each of these members over lap. This may be achieved where the holding member is a suture cord by sewing the suture cord through each of the first member, the second member and the bridging member and then fastening it at the point of connection.
- the first and second members may be of any shape or dimension. Preferably, they are shaped such that in use, when a portion of the first and second members are drawn though the tissue or muscle wall defect the members overlap, in the region of the defect while at the same time covering the surrounding tissue without forming a substantial distortion to the layer of the member like that which might be formed from wrinkles or creases or crumpling of the members. Most preferably the members are of such a size and shape that they cover a substantial portion of the tissue in the general locality of the defect, and of a construction which allows them to conform to the contours of the tissue without crumpling in a way that leads to creases or a folding of the members.
- the holding member(s) may be made from any material that is capable of securing the first and second members in place.
- the holding member is made of cord engaged (eg by sewing or tying) to the overlap between the first and second members. Most preferably, the cord is adapted to receive a needle capable of penetrating a patient's tissue.
- the cord may be for example suture cord or any other cord that is suitable for use in a patient.
- the holding member preferably passes through either the tissue or muscle wall defect or the internal ring where it may either engage the tissue in a fastening manner or pass back through the tissue in which the hernia is formed at a distance away from the hernia which equates to the size of either the first or second member.
- the holding member is then attached to the member, therein fastening the prosthetic in place. Any means for attaching the holding member to the member may be used.
- Most preferably the holding member is tied to the member.
- each member should be capable of passing through either the tissue or muscle wall defect or the internal ring and then back through the tissue in which the tissue or muscle wall defect is formed at a distance, away from the tissue or muscle wall defect, which equates to the size of either the first or second member to which it would attach.
- the first or second member may engage at least a securing means.
- the securing member is adapted to pass through the tissue which the members cover and in which there is a tissue or muscle wall defect. The securing means and the holding member may then be connected (eg by tying or through any other means) therein holding the prosthetic in place.
- the securing means may be a glue or glue like substance that is capable of binding or engaging the members with the tissue under repair.
- the glue or glue like substance may be a fibrin based glue like tissel glue.
- one or more engaging means attached to the first and or second member, which are capable of engaging the - 6 - first or second members to assist in defining the relative shape of the members when located in situ.
- the prosthetic is composed of a substantially porous prosthetic repair material that is capable of being compressed into an implanting condition such that it fits within a surgical tube and can be expanded upon deployment when brought into spacial proximity with the tissue or muscle wall defect which it is used to repair.
- the porous prosthetic repair material may contain one or more ribs which serve to return the members to their shape when deployed into position.
- first member and second member may be of any shape, they are each preferably cut to minimise folding or creasing when implanted in situ.
- first member is generally heart shaped while the second member is generally diamond shaped.
- the heart shaped first member preferably overlaps with the diamond shaped second member at the top of the heart.
- the second member is connected to the first member at the recess in the top of the heart.
- the exact size and shape of the mesh material may be determined by the surgeon depending upon the particular repair being performed and the age and size of the patient.
- the members are of such a size that they cover muscle tissue in the general locality in which there is a propensity for hernias to form.
- the mesh from which the prosthesis is formed needs to account for irregularities in the shape of the rupture.
- the mesh should be capable of adapting to the slender configuration that approximates the shape of the defect.
- the mesh should preferably be compressible into varying shapes and sizes allowing a single or at most a nominal range of sizes to be indicated for the repair of most commonly occurring inguinal defects and soft tissue reconstruction
- the biologically compatible implantable prosthesis is preferable formed of knitted polypropylene monofilament mesh fabric, such as ProleneTM mesh or monocril - 7 - mesh.
- Other biologically compatible soft tissue reconstruction or repair material, having openings for ingrowth are contemplated within the scope of the invention are, without limitation, MarlexTM, DacronTM, TeflonTM (expanded PTFE) and MerseleneTM.
- the poms prosthetic repair material may alternatively be formed of multi-filament yarns in a woven or braided arrangement.
- the material should be adapted to ensure porosity for tissue in-growth.
- the material should be capable of some flexibility, enabling it to conform to the shape of the hernia.
- the invention consists in a method of repairing or reconstructing a tissue or muscle wall defect, comprising the steps of:
- the invention is used for hernia repair operations.
- the method of the invention is performed by an operator drawing the holding member through either the hernia or the internal ring depending on the type of hernia being treated.
- the holding member After the holding member has passed through the hernia a small portion of the first member and second member is also pulled through the hernia therein forming a plug.
- the remainder of the prosthetic is then flattened out over the tissue surrounding the area thus covering the direct hernia present or preventing future direct hernias from occurring.
- the holding means is then passed back through the surrounding muscle tissue so that it can be fastened to either the first member or the second member.
- Figure 1 illustrates a prosthetic prepared according to the preferred form of the invention.
- Figure 2 illustrates a prosthetic prepared according to the preferred form of the invention and the means by which it is inserted in place.
- Figure 3 illustrates a prosthetic located in situ in a patient.
- FIG. 1 illustrates a prosthetic 2 (shown generally) prepared according to the preferred form of the invention, containing a first member 4, a second member 6 and a bridging member 8.
- the bridging member 8 is provided as the connection between the first and second members and is attached within the recess at the top of the heart shaped arrangement of the first member 4 and to the bottom of the diamond shaped arrangement of the second member 6.
- Use of a bridging member 8 ensures that the first and second members remain together.
- the bridging member also provides a further (third) layer of structural support in the connection region 10 which is where the holding member (not shown) attaches.
- the bridging member is shown as being postioned equidistant between the two sides of the first member.
- the bridging member need not be located in such a precise position but may be directed further towards one side of the first and second members as compared to the other side of those members.
- the first member 4 is substantially greater in size compared to the second member 6 and is cut in a grotesque heart shape.
- the first member 4 is adapted in this way to cover tissue surrounding the hernia or if the prosthetic is placed through the internal ring, the hernia itself.
- the first and second members are folded over each other in the manner illustrated by the arrow 12 in the diagram.
- the upper portion 16 of the heart shaped first member and the bottom portion 18 of the diamond shaped second member overlap (not shown) therein forming a double layer of material in the overlap area 14.
- Such an overlap provides the prosthetic with an additional level of strength in this region.
- Figure 2 illustrates the manner by which the prosthetic is applied to tissue to cover a hernia.
- the figure shows the flat abdominal muscles 21 , the iliacus muscle 23, the psoas muscle 25, the iliac vessels 27, the vas 29.
- the holding means 20 passes through the internal ring 26.
- the holding means is then used to pull the prosthetic against the tissue and hernia 22 to be covered.
- Once the prosthetic has been layed out to cover the treatment zone 24 a small amount of the first and second members is then pulled through the internal ring therein forming a plug within the internal ring.
- the holding means is then passed back through the tissue covered by the prosthetic and attached to the first member. In each instance the connection of the holding member to the connection region and the first member is made via knots made using the holding member.
- FIG 3 illustrates the prosthetic applied to tissue requiring treatment. From this illustration it can be seen that the prosthetic is applied to the treatment zone covering the hernia. Drawing numbers are according to figures 1 and 2.
- a patient is anaesthetised and markings are made on the abdomen, anterior super iliac, spine, the pubic tubercle, the - 10 - inguinal ligament, and the femoral vessels. Markings are also made for the port sites.
- a 1 cm incision was made below the umbilicus enabling the anterior rectus sheath to be opened.
- the rectus muscle was then pushed away to one side exposing the posterior sheath.
- a blunt dissection was then performed; first with a finger, then a 10mm blunt obturator was pushed down the midline and a blunt dissection was carried out in the extraperitoneal space up to pubic bone.
- a second suture of 3(0) monocril was passed from outside the patient about 5-8cm above the pubic tubercle near the mid line, through an I.V. cannula or through a Verhees Needle in the extra epritoneal space.
- the suture was pulled out from the extraperitoneal space through the 10-12 mm port.
- the first suture was kept taught by an assistant while a grasper was used to pick up the second suture thus preventing a loop being formed. Formation of a loop can prevent the present invention from unfolding properly.
- the second suture was then tied to the mesh towards the - 1 1 - medial end of the upper border, approximately 8-1 Ocm away from the previous suture, depending upon the size of the patient.
- the mesh of the invention was then grasped with a non-toothed grasper over the first suture at the folded area and then pushed inside the 10-12 mm port and gradually pushed towards the Internal Ring along with the port.
- the first suture should be pulled simultaneously by the assistant gently.
- the port also can also be gently pulled back towards the abdominal wall at the same time the second suture can be gradually pulled by the assistant. This facilitates the mesh to unfold easily. Following this, the mesh should be flattened out in all directions.
Abstract
Description
Claims
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
AU35131/99A AU756106B2 (en) | 1998-05-06 | 1999-05-04 | Laparoscopic hernia repair |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
AUPP3355A AUPP335598A0 (en) | 1998-05-06 | 1998-05-06 | Laparoscopic hernia repair |
AUPP3355 | 1998-05-06 |
Publications (1)
Publication Number | Publication Date |
---|---|
WO1999056664A1 true WO1999056664A1 (en) | 1999-11-11 |
Family
ID=3807609
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/AU1999/000329 WO1999056664A1 (en) | 1998-05-06 | 1999-05-04 | Laparoscopic hernia repair |
Country Status (2)
Country | Link |
---|---|
AU (1) | AUPP335598A0 (en) |
WO (1) | WO1999056664A1 (en) |
Cited By (18)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO2004012627A1 (en) * | 2002-08-02 | 2004-02-12 | C.R.Bard, Inc. | Implantable prosthesis |
US6736854B2 (en) | 2002-05-10 | 2004-05-18 | C. R. Bard, Inc. | Prosthetic repair fabric with erosion resistant edge |
US6736823B2 (en) | 2002-05-10 | 2004-05-18 | C.R. Bard, Inc. | Prosthetic repair fabric |
US7011688B2 (en) | 2002-05-10 | 2006-03-14 | C.R. Bard, Inc. | Prosthetic repair fabric |
US7828854B2 (en) | 2006-10-31 | 2010-11-09 | Ethicon, Inc. | Implantable repair device |
CN102247221A (en) * | 2011-06-24 | 2011-11-23 | 王明刚 | Three-dimensional patch for repairing inguinal hernia by virtue of laparoscopy |
US9119698B2 (en) | 2001-08-03 | 2015-09-01 | Juan Manuel Bellon Caneiro | Wall prosthesis that can be implanted in the center of a wound to reinforce abdominal wall closure |
US9220585B2 (en) | 2009-09-08 | 2015-12-29 | Atrium Medical Corporation | Hernia patch |
CN106236321A (en) * | 2016-07-26 | 2016-12-21 | 南京市第医院 | Before peritoneum, inguinal hernia repairs sticking patch |
US9713519B2 (en) | 2012-01-06 | 2017-07-25 | Atrium Medical Corporation | Implantable prosthesis |
US10478281B2 (en) | 2014-12-24 | 2019-11-19 | C.R. Bard, Inc. | Implantable prosthesis for soft tissue repair |
US10772995B2 (en) | 2004-09-28 | 2020-09-15 | Atrium Medical Corporation | Cross-linked fatty acid-based biomaterials |
US10792312B2 (en) | 2004-09-28 | 2020-10-06 | Atrium Medical Corporation | Barrier layer |
US10814043B2 (en) | 2004-09-28 | 2020-10-27 | Atrium Medical Corporation | Cross-linked fatty acid-based biomaterials |
US10864304B2 (en) | 2009-08-11 | 2020-12-15 | Atrium Medical Corporation | Anti-infective antimicrobial-containing biomaterials |
US11083823B2 (en) | 2005-09-28 | 2021-08-10 | Atrium Medical Corporation | Tissue-separating fatty acid adhesion barrier |
US11097035B2 (en) | 2010-07-16 | 2021-08-24 | Atrium Medical Corporation | Compositions and methods for altering the rate of hydrolysis of cured oil-based materials |
US11166929B2 (en) | 2009-03-10 | 2021-11-09 | Atrium Medical Corporation | Fatty-acid based particles |
Citations (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO1992013500A1 (en) * | 1991-02-08 | 1992-08-20 | Surgical Innovations, Inc. | Method and apparatus for repair of inguinal hernias |
EP0836838A1 (en) * | 1996-10-18 | 1998-04-22 | Cogent | Anatomical prosthesis for hernia repair via open of laparoscopic surgery |
-
1998
- 1998-05-06 AU AUPP3355A patent/AUPP335598A0/en not_active Abandoned
-
1999
- 1999-05-04 WO PCT/AU1999/000329 patent/WO1999056664A1/en active IP Right Grant
Patent Citations (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO1992013500A1 (en) * | 1991-02-08 | 1992-08-20 | Surgical Innovations, Inc. | Method and apparatus for repair of inguinal hernias |
EP0836838A1 (en) * | 1996-10-18 | 1998-04-22 | Cogent | Anatomical prosthesis for hernia repair via open of laparoscopic surgery |
Cited By (30)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US9119698B2 (en) | 2001-08-03 | 2015-09-01 | Juan Manuel Bellon Caneiro | Wall prosthesis that can be implanted in the center of a wound to reinforce abdominal wall closure |
US6736854B2 (en) | 2002-05-10 | 2004-05-18 | C. R. Bard, Inc. | Prosthetic repair fabric with erosion resistant edge |
US6736823B2 (en) | 2002-05-10 | 2004-05-18 | C.R. Bard, Inc. | Prosthetic repair fabric |
US7011688B2 (en) | 2002-05-10 | 2006-03-14 | C.R. Bard, Inc. | Prosthetic repair fabric |
US7879108B2 (en) | 2002-05-10 | 2011-02-01 | C. R. Bard, Inc. | Prosthetic repair fabric with erosion resistant edge |
US8956373B2 (en) | 2002-08-02 | 2015-02-17 | C.R. Bard, Inc. | Implantable prosthesis |
US7785334B2 (en) | 2002-08-02 | 2010-08-31 | C.R. Bard, Inc. | Implantable prosthesis |
US7806905B2 (en) | 2002-08-02 | 2010-10-05 | C.R. Bard, Inc. | Implantable prosthesis |
WO2004012627A1 (en) * | 2002-08-02 | 2004-02-12 | C.R.Bard, Inc. | Implantable prosthesis |
US10814043B2 (en) | 2004-09-28 | 2020-10-27 | Atrium Medical Corporation | Cross-linked fatty acid-based biomaterials |
US10772995B2 (en) | 2004-09-28 | 2020-09-15 | Atrium Medical Corporation | Cross-linked fatty acid-based biomaterials |
US11793912B2 (en) | 2004-09-28 | 2023-10-24 | Atrium Medical Corporation | Cross-linked fatty acid-based biomaterials |
US10869902B2 (en) | 2004-09-28 | 2020-12-22 | Atrium Medical Corporation | Cured gel and method of making |
US10792312B2 (en) | 2004-09-28 | 2020-10-06 | Atrium Medical Corporation | Barrier layer |
US11083823B2 (en) | 2005-09-28 | 2021-08-10 | Atrium Medical Corporation | Tissue-separating fatty acid adhesion barrier |
US9636207B2 (en) | 2006-10-31 | 2017-05-02 | Ethicon, Inc. | Implantable repair device |
US7828854B2 (en) | 2006-10-31 | 2010-11-09 | Ethicon, Inc. | Implantable repair device |
US8388633B2 (en) | 2006-10-31 | 2013-03-05 | Ethicon, Inc. | Implantable repair device |
US8591534B2 (en) | 2006-10-31 | 2013-11-26 | Ethicon, Inc. | Implantable repair device |
US11166929B2 (en) | 2009-03-10 | 2021-11-09 | Atrium Medical Corporation | Fatty-acid based particles |
US10864304B2 (en) | 2009-08-11 | 2020-12-15 | Atrium Medical Corporation | Anti-infective antimicrobial-containing biomaterials |
US9220585B2 (en) | 2009-09-08 | 2015-12-29 | Atrium Medical Corporation | Hernia patch |
US10603153B2 (en) | 2009-09-08 | 2020-03-31 | Atrium Medical Corporation | Hernia patch |
US11097035B2 (en) | 2010-07-16 | 2021-08-24 | Atrium Medical Corporation | Compositions and methods for altering the rate of hydrolysis of cured oil-based materials |
CN102247221A (en) * | 2011-06-24 | 2011-11-23 | 王明刚 | Three-dimensional patch for repairing inguinal hernia by virtue of laparoscopy |
US9713519B2 (en) | 2012-01-06 | 2017-07-25 | Atrium Medical Corporation | Implantable prosthesis |
US11617637B2 (en) | 2014-12-24 | 2023-04-04 | C.R. Bard, Inc. | Implantable prosthesis for soft tissue repair |
US11617638B2 (en) | 2014-12-24 | 2023-04-04 | C.R. Bard, Inc. | Implantable prosthesis for soft tissue repair |
US10478281B2 (en) | 2014-12-24 | 2019-11-19 | C.R. Bard, Inc. | Implantable prosthesis for soft tissue repair |
CN106236321A (en) * | 2016-07-26 | 2016-12-21 | 南京市第医院 | Before peritoneum, inguinal hernia repairs sticking patch |
Also Published As
Publication number | Publication date |
---|---|
AUPP335598A0 (en) | 1998-05-28 |
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