Modified fixation free plug technique using a new 3D multilamellar implant for inguinal hernia repair

A retrospective study of a single operator case series

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Implant fixation, mesh shrinkage and poor quality of tissue ingrowth are unresolved issues in modern hernia repair. Many complications reported in the literature such as bleeding, nerve entrapment, hematoma, pain, discomfort, and testicular complications, are considered to be a direct results of implant fixation. This article describes the outcomes of a procedure carried out using a handcrafted implant that addresses the issues consequent to point fixation.


This was a retrospective study on the short, medium and long-term results of placing a-modified, fixation free three-dimensional polypropylene implant in 61 patients who underwent inguinal hernia repair using a novel delivery technique. The follow up length was at least 36 months postop.


Only minor adverse events and a low complication rate of the procedure were observed in this patient sample. There were no long- term complications. Postoperative pain was very low in both the short and long term. No chronic pain was reported. No recurrences occurred.


The results of this retrospective study on a new method of inguinal hernia repair using a three dimensional handcrafted multilamellar implant delivered with a modified placement technique are promising. The short-, medium- and long-term complications were notably low. No recurrences were noticed but, more importantly, no chronic pain and extremely low discomfort rates were observed even in the long term.

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  1. 1.

    Rutkow IM (2003) Demographic and socioeconomic aspects of hernia repair in the United States. Surg Clin North Am 2003(83):1045–1051

  2. 2.

    Bassini E (1889) Nuovo metodo operativo per la cura dell’ernia inguinale. Padua

  3. 3.

    Read RC (2003) Recent advances in the repair of groin herniation. Curr Probl Surg 40(1):13–79

  4. 4.

    Lichtenstein I, Shulman A (1986) Ambulatory outpatient hernia surgery. Including a new concept, introducing tension-free repair. Int Surg 71(1):1–4

  5. 5.

    Amid PK (2004) Causes, prevention, and surgical treatment of postherniorrhaphy neuropathic inguinodynia: triple neurectomy with proximal end implantation. Hernia 8:343–349

  6. 6.

    O’Dwyer PJ, Kingsnorth AN, Mohillo RG, Small PK, Lammers B, Horeysee G (2005) Randomized clinical trial assessing impact of a lightweight or heavyweight on chronic pain after inguinal hernia repair. Br J Surg 92:166–170

  7. 7.

    Rutkow IM, Robbins AW (1995) Mesh plug hernia repair: a follow-up report. Surgery 117:597–598

  8. 8.

    Aasvang E, Kehlet H (2005) Surgical management of chronic pain after inguinal hernia repair. Br J Surg 92:795–801

  9. 9.

    Amato G, Lo Monte AI, Cassata G, Damiano G, Romano G, Bussani R (2012) A new prosthetic implant for inguinal hernia repair: its features in a porcine experimental model. Artif Organs 35(8):E181–E190

  10. 10.

    Amato G, Romano G, Salamone G, Agrusa A, Di Buono G, Gulotta G (2012) Fixation-free inguinal hernia repair, using a dynamic self-retaining implant inducing enhanced biologic response. Results of a midterm follow up. Hernia 16(Suppl 1):S85–S87

  11. 11.

    Amato G, Marasa L, Sciacchitano T, Bell SG, Romano G, Gioviale MC, Lo Monte AI, Romano M (2009) Histological findings of the internal inguinal ring in patients having indirect inguinal hernia. Hernia 13(3):259–262

  12. 12.

    Amato G, Romano G, Salamone G, Agrusa A, Gulotta G, Ober E, Bussani R (2011) Nerve degeneration in inguinal hernia specimens. Hernia 15:53–58

  13. 13.

    Amato G (2010) Reply to the letter: “Histology of the internal inguinal ring: it is really a novelty?”. Hernia 14:665–667

  14. 14.

    Amato G, Romano G, Agrusa A, Salamone G, Saladino VA, Silvestri F, Bussani R (2012) Damage to the vascular structures in inguinal hernia specimens. Hernia 16:63–67

  15. 15.

    Amato G, Agrusa A, Romano G, Salamone G, Gulotta G, Silvestri F, Bussani R (2012) Muscle degeneration in inguinal hernia specimens. Hernia 16:327–331

  16. 16.

    Amato G, Sciacchitano T, Bell SG, Romano G, Cocchiara G, Lo Monte AI, Romano M (2009) Sphincter-like motion following mechanical dilation of the rings Internal inguinal hernia during indirect procedures. Hernia 13:67–72

  17. 17.

    Kim-Fuchs C, Angst E, Vorburger S, Heibling C, Candinas D, Schlumpf R (2012) Prospective randomized trial comparing sutured with sutureless mesh fixation for Lichtenstein hernia repair: long-term results. Hernia 16(1):21–27

  18. 18.

    Negro P, Basile F, Brescia A, Buonanno GM, Campanelli G, Canonico S, Cavalli M, Corrado G, Coscarella G, Di Lorenzo N, Falletto E, Fei L, Francucci M, Fronticelli Baldelli C, Gaspari AL, Gianetta E, Marvaso A, Palumbo P, Pellegrino N, Piazzai R, Salvi PF, Stabilini C, Zanghì G (2012) Open tension-free Lichtenstein repair of inguinal hernia: use of fibrin glue versus sutures for mesh fixation. Hernia 15(1):7–14

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Conflict of interest

A. G declares having received funds in relation with this study. Other authors declare no conflict of interest.

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Correspondence to G. Amato.

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Amato, G., Agrusa, A., Romano, G. et al. Modified fixation free plug technique using a new 3D multilamellar implant for inguinal hernia repair. Hernia 18, 243–250 (2014) doi:10.1007/s10029-013-1102-y

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  • Hernia
  • Inguinal
  • Herniorrhaphy
  • Prostheses and implants
  • Prosthesis fixation