Mesh Plug Repair

  • Francesco GossettiEmail author
  • Linda D’Amore
  • Maria Romana Grimaldi
  • Francesca Ceci
  • Paolo Negro


Besides the Lichtenstein technique, the mesh plug repair (MPR) has demonstrated excellent results over the years, with recurrence, chronic pain, and quality of life rates comparable to Lichtenstein’s in most of the reported outcomes. MPR is a deep repair with the device laying in the pre-peritoneal space. The technique was originally proposed in the late 1980s by Gilbert and Trabucco and finally standardized by Rutkow, who introduced the first preformed plug (PerFix™). Since then, many 3D devices have been offered on the market, made with new materials and new profiles, to meet the current requirements of the hernia surgery and overcome criticisms addressed to this technique, such as the excessive use of foreign material and the risk of plug migration. In fact, choosing the proper plug besides paying attention to technical details can reduce migration that seems anyway very rare. Originally proposed for all groin hernias, MPR today should be indicated for the treatment of lateral, recurrent “internal,” and femoral hernias, according to a tailored management of inguinal hernia. MPR offers the fastest learning curve, the shortest operative time, and the lowest perceived difficulty among all the procedures for groin hernia repair. It should remain in the toolbox of all general surgeons.


  1. 1.
    Negro P, Gossetti F, Ceci F, Manto O, D’Amore L. Davide Fieschi: a pioneer of plug repair in groin hernia surgery. Hernia. 2014;18:919–23.CrossRefPubMedGoogle Scholar
  2. 2.
    Gilbert AI. An anatomical and functional classification for the diagnosis and treatment of inguinal hernia. Am J Surg. 1989;157:331–3.CrossRefPubMedGoogle Scholar
  3. 3.
    Trabucco EE. Routine sutureless mesh in primary inguinal hernioplasty. Am Coll Surg. 1989;13:541–4.Google Scholar
  4. 4.
    Rutkow IM, Robbins AW. 1669 mesh plug hernioplasties. Contemp Surg. 1993;43:141–7.Google Scholar
  5. 5.
    Rutkow IM, Robbins AW. Mesh plug hernia repair: a follow-up report. Surgery. 1995;117:597–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Read R. Milestones in the history of hernia surgery: prosthetic repair. Hernia. 2004;8:8–14.CrossRefPubMedGoogle Scholar
  7. 7.
    Gilbert AI, Graham MF, Voigt WL. A bilayer devices for inguinal hernia repair. Hernia. 1999;3:161–6.CrossRefGoogle Scholar
  8. 8.
    Campanelli GP, Pettinari D, Nicolosi FM, Cavalli M, Contessini Avesani E. Inguinal hernia recurrence: classification and approach. Hernia. 2006;10:159–61.CrossRefPubMedGoogle Scholar
  9. 9.
    Pelissier EP, Blum D, Dams JM, Marre P. The plug method in inguinal hernia: a prospective evaluation. Hernia. 1999;4:201–4.Google Scholar
  10. 10.
    Millikan KW, Cummings B, Doolas A. A prospective study of the mesh plug hernioplasty. Am Surg. 2001;67:285–9.PubMedGoogle Scholar
  11. 11.
    Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, de Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Miserez M. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2009;13:343–403.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Miserez M, Peeters E, Aufenacker T, Bouillot JL, Campanelli G, Conze J, Fortelny R, Heikkinen T, Jorgensen LN, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Simons MP. Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2014;18:151–63.CrossRefPubMedGoogle Scholar
  13. 13.
    Weyhe D. New worldwide guidelines for treatment of inguinal hernia: the most important recommendations from HerniaSurge. Chirurg. 2017;88(7):628. Scholar
  14. 14.
    Kingsnorth AN, Porter CS, Bennett DH, Walker AJ, Hyland ME, Sodergren S. Lichtenstein patch or Perfix plug-and-patch in inguinal hernia: a prospective double-blind randomized controlled trial of short-term outcome. Surgery. 2000;127:276–83.CrossRefPubMedGoogle Scholar
  15. 15.
    Kingsnorth AN, Hyland M, Porter RN, Sodergren S. Perfix plug and patch versus Lichtenstein patch in inguinal hernia: prospective randomized double-blind study of medium-term outcome. Proceedings from “Hernia in the 21st Century” (Toronto, 2000), Meeting book; 2002. p. 246.Google Scholar
  16. 16.
    Testini M, Miniello S, Piccinni G, Di Venere B, Lissidini G, Greco L, Bonomo GM. Trabucco versus Rutkow versus Lichtenstein techniques in the treatment of groin hernia. A controlled randomized clinical trial. Minerva Chir. 2002;57:371–6.PubMedGoogle Scholar
  17. 17.
    Bringman S, Ramel S, Heikkinen TJ, Englund T, Westman B, Anderberg B. Tension-free inguinal hernia repair: TEP versus mesh-plug versus Lichtenstein: a prospective randomized controlled trial. Ann Surg. 2003;237:142–7.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Adamonis W, Witkowski P, Smietański M, Bigda J, Sledziński Z. Is there a need for a mesh plug in inguinal hernia repair? Randomized, prospective study of the use of Hertra 1 mesh compared to PerFix plug. Hernia. 2006;10:223–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Bolognini S, Orsini V, Grandinetti PP, Pata F, Sacco R. Lichtenstein vs. Rutkow-Robbins technique in the treatment of primary inguinal hernia. Analysis of the long term results. Ann Ital Chir. 2006;77:51–6.PubMedGoogle Scholar
  20. 20.
    Horharin P, Wilasrusmee C, Cherudchayaporn K, Pinyaku N, Phanpradi O, Phromsopha N. Comparative study of tailor-made mesh plug herniorrhaphy versus Lichtenstein herniorrhaphy versus Bassini operation: a prospective clinical trial. Asian J Surg. 2006;29:74–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Frey DM, Wildisen A, Hamel CT, Zuber M, Oertli D, Metzger J. Randomized clinical trial of Lichtenstein's operation versus mesh plug for inguinal hernia repair. Br J Surg. 2007;94:36–41.CrossRefPubMedGoogle Scholar
  22. 22.
    Sanders DL, Samarakoon DH, Ganshirt SW, Porter CS, Kingsnorth AN. A two-centre blinded randomised control study comparing the Lichtenstein patch, Perfix plug and ProLoop plug in the repair of primary inguinal hernia. Hernia. 2009;13:499–503.CrossRefPubMedGoogle Scholar
  23. 23.
    Droeser RA, Dell-Kuster S, Kurmann A, Rosenthal R, Zuber M, Metzger J, Oertli D, Hamel CT, Frey DM. Long-term follow-up of a randomized controlled trial of Lichtenstein’s operation versus mesh plug repair for inguinal hernia. Ann Surg. 2014;259:966–72.CrossRefPubMedGoogle Scholar
  24. 24.
    Ripetti V, La Vaccara V, Greco S, Bono F, Valeri S, Coppola R. Randomised trial comparing Lichtenstein vs Trabucco vs Valenti techniques in inguinal hernia repair. Hernia. 2014;18:205–12.CrossRefPubMedGoogle Scholar
  25. 25.
    Nienhuijs SW, van Oort I, Keemers-Gels ME, Strobbe LJ, Rosman C. Randomized trial comparing the Prolene Hernia System, mesh plug repair and Lichtenstein method for open inguinal hernia repair. Br J Surg. 2005;92:33–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Mayagoitia JC, Prieto-Díaz Chávez E, Suárez D, Cisneros HA, Tene CE. Predictive factors comparison of complications and recurrences in three tension-free herniorraphy techniques. Hernia. 2006;10:147–51.CrossRefPubMedGoogle Scholar
  27. 27.
    Dalenbäck J, Andersson C, Anesten B, Björck S, Eklund S, Magnusson O, Rimbäck G, Stenquist B, Wedel N. Prolene Hernia System, Lichtenstein mesh and plug-and-patch for primary inguinal hernia repair: 3-year outcome of a prospective randomised controlled trial. The BOOP study: bi-layer and connector, on-lay, and on-lay with plug for inguinal hernia repair. Hernia. 2009;13:121–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Nienhuijs SW, Rosman C. Long-term outcome after randomizing prolene hernia system, mesh plug repair and Lichtenstein for inguinal hernia repair. Hernia. 2015;19:77–81.CrossRefPubMedGoogle Scholar
  29. 29.
    Zhao G, Gao P, Ma B, Tian J, Yang K. Open mesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials. Ann Surg. 2009;250:35–42.CrossRefPubMedGoogle Scholar
  30. 30.
    Li J, Ji Z, Li Y. Comparison of mesh-plug and Lichtenstein for inguinal hernia repair: a meta-analysis of randomized controlled trials. Hernia. 2012;16:541–8.CrossRefPubMedGoogle Scholar
  31. 31.
    Negro P, D'Amore L, Gossetti F. Mesh plug repair and surgeon's satisfaction. Hernia. 2010;14:223–34.CrossRefPubMedGoogle Scholar
  32. 32.
    Huang CS, Huang CC, Lien HH. Prolene hernia system compared with mesh plug technique: a prospective study of short- to mid-term outcomes in primary groin hernia repair. Hernia. 2005;9:167–71.CrossRefPubMedGoogle Scholar
  33. 33.
    Agrawal A, Avill R. Mesh migration following repair of inguinal hernia: a case report and review of literature. Hernia. 2006;10:79–82.CrossRefPubMedGoogle Scholar
  34. 34.
    Jeans S, Williams GL, Stephenson BM. Migration after open mesh plug inguinal hernioplasty: a review of the literature. Am Surg. 2007;73:207–9.PubMedGoogle Scholar
  35. 35.
    Dieter RA Jr. Mesh plug migration into scrotum: a new complication of hernia repair. Int Surg. 1999;84:57–9.PubMedGoogle Scholar
  36. 36.
    Nowak DD, Chin AC, Singer MA, Helton WS. Large scrotal hernia: a complicated case of mesh migration, ascites, and bowel strangulation. Hernia. 2005;9:96–9.CrossRefPubMedGoogle Scholar
  37. 37.
    Chuback JA, Singh RS, Sills C, Dick LS. Small bowel obstruction resulting from mesh plug migration after open inguinal hernia repair. Surgery. 2000;127:475–6.CrossRefPubMedGoogle Scholar
  38. 38.
    Tokunaga Y, Tokuka A, Ohsumi K. Sigmoid colon diverticulosis adherent to mesh plug migration after open inguinal hernia repair. Curr Surg. 2001;58:493–4.CrossRefPubMedGoogle Scholar
  39. 39.
    Moorman ML, Price PD. Migrating mesh plug: complication of a well-established hernia repair technique. Am Surg. 2004;70:298–9.PubMedPubMedCentralGoogle Scholar
  40. 40.
    Benedetti M, Albertario S, Niebel T, Bianchi C,Tinozzi FP, Moglia P, Arcidiaco M, Tinozzi S. Intestinal perforation as a long-term complication of plug and mesh inguinal hernioplasty: case report. Hernia. 2005;9:93–5.CrossRefPubMedGoogle Scholar
  41. 41.
    Murphy JW, Misra DC, Silverglide B. Sigmoid colonic fistula secondary to Perfix-plug, left inguinal hernia repair. Hernia. 2006;10:436–8.CrossRefPubMedGoogle Scholar
  42. 42.
    Ojo P, Abenthroth A, Fiedler P, Yavorek G. Migrating mesh mimicking colonic malignancy. Am Surg. 2006;72:1210–1.PubMedGoogle Scholar
  43. 43.
    Zubaidi AM, Al Saghier M, Kabbani M, Abdo A. Colocutaneous fistula after mesh plug inguinal hernia repair- a delayed complication. Ann Saudi Med. 2006;26:385–7.CrossRefPubMedGoogle Scholar
  44. 44.
    Stout CL, Foret A, Christie DB, Mullis E. Small bowel volvulus caused by migrating mesh plug. Am Surg. 2007;73:796–7.PubMedGoogle Scholar
  45. 45.
    Liang X, Cai XJ, Yu H, Wang YF. Strangulated bowel obstruction resulting from mesh plug migration after open inguinal hernioplasty: case report. Chin Med J. 2008;121:183–4.PubMedGoogle Scholar
  46. 46.
    Ortiz JA, Palladino H, Thomas S, Zaki R. Mesh plug and ureteral necrosis after kidney transplantation. Hernia. 2008;12:433–5.CrossRefPubMedGoogle Scholar
  47. 47.
    Ishiguro Y, Horie H, Satoh H, Miyakura Y, Yasuda Y, Lefor AT. Colocutaneous fistula after left inguinal hernia repair using the mesh plug technique. Surgery. 2009;145:120–1.CrossRefPubMedGoogle Scholar
  48. 48.
    Chen MJ, Tian YF. Intraperitoneal migration of a mesh plug with a small intestinal perforation: report of a case. Surg Today. 2010;40:566–8.CrossRefPubMedGoogle Scholar
  49. 49.
    Ratajczak A, Kościński T, Banasiewicz T, Lange-Ratajczak M, Hermann J, Bobkiewicz A, Drews M. Migration of biomaterials used in gastroenterological surgery. Pol Przegl Chir. 2013;85:377–80.CrossRefPubMedGoogle Scholar
  50. 50.
    Yilmaz I, Karakaş DO, Sucullu I, Ozdemir Y, Yucel E. A rare cause of mechanical bowel obstruction: mesh migration. Hernia. 2013;17:267–9.CrossRefPubMedGoogle Scholar
  51. 51.
    Ishikawa S, Kawano T, Karashima R, Arita T, Yagi Y, Hirota M. A case of mesh plug migration into the bladder 5 years after hernia repair. Surg Case Rep. 2015;1(1):4. Scholar
  52. 52.
    Sekiguchi K, Mizuguchi Y, Mamada Y, Koizumi M, Uchida E. Intraperitoneal migration of a mesh plug from a hernioplasty forming a colocutaneous fistula with the cecum: report of a case. J Nippon Med Sch. 2015;82:246–9.CrossRefPubMedGoogle Scholar
  53. 53.
    Yamamoto S, Kubota T, Abe T. A rare case of mechanical bowel obstruction caused by mesh plug migration. Hernia. 2015;19:983–5.CrossRefPubMedGoogle Scholar
  54. 54.
    Scaringi S, Ardu M, Zambonin D, Giudici F, Bechi P. Sigmoidocutaneous fistula 26 years after left inguinal hernia repair with mesh-plug technique. Am Surg. 2016;82:E52–3.PubMedGoogle Scholar
  55. 55.
    Veroux M, Ardita V, Zerbo D, Caglià P, Palmucci S, Sinagra N, Giaquinta A, Veroux P. First case report of acute renal failure after mesh-plug inguinal hernia repair in a kidney transplant recipient. Medicine (Baltimore). 2016;95(13):e3199. Scholar
  56. 56.
    Eid JJ, Rodriguez A, Radecke JM, Murr MM. An unusual cecal mass on routine colonoscopy. J Surg Case Rep. 2014;2014(11):rju119. Scholar
  57. 57.
    Scheuer LS, Schnelldorfer T. Inguinal hernia mesh plug migrated into the abdominal cavity. J Gastrointest Surg. 2015;19:1187–8.CrossRefPubMedGoogle Scholar
  58. 58.
    LeBlanc KA. Complications associated with the plug-and-patch method of inguinal herniorraphy. Hernia. 2001;5:135–8.CrossRefPubMedGoogle Scholar
  59. 59.
    Negro P, Gossetti F, D'Amore L, Proposito D, Vermeil V, Battillocchi B, Della Rocca G, Carboni M. 1,000 prosthetic hernia repairs: experience of a dedicated team. Chir Ital. 2000;52:279–88.PubMedGoogle Scholar
  60. 60.
    Pikoulis E, Daskalakis P, Psallidas N, Karavokyros I, Stathoulopolos A, Godevenos D, Leppaniemi A, Tsatsoulis P. Marlex mesh Prefix plug hernioplasty retrospective analysis of 865 operations. World J Surg. 2005;229:231–4.CrossRefGoogle Scholar
  61. 61.
    Millikan KW, Doolas A. A long-term evaluation of the modified mesh-plug hernioplasty in over 2,000 patients. Hernia. 2008;12:257–60.CrossRefPubMedGoogle Scholar
  62. 62.
    Negro P, D’Amore L, Gossetti F, Battilocchi B, Vermeil V, Dandolo R. Follow-up of plug in long run hernia surgery. Results from a national inquiry. Hernia. 2001;5(Suppl 1):S31.Google Scholar
  63. 63.
    Negro P, Gossetti F, Dassatti M, Manzi E, D’Amore L. Plug repair. Hernia. 2012;(Suppl 1):S42.Google Scholar
  64. 64.
    Hamouda A, Kennedy J, Grant N, Nigam A, Karanjia N. Mesh erosion into the urinary bladder following laparoscopic inguinal hernia repair; is this the tip of the iceberg? Hernia. 2010;14:317–9.CrossRefPubMedGoogle Scholar
  65. 65.
    D'Amore L, Gossetti F, Manto O, Negro P. Mesh plug repair: can we reduce the risk of plug erosion into the sigmoid colon? Hernia. 2012;16:495–6.CrossRefPubMedGoogle Scholar
  66. 66.
    Mutter D, Champault G, Binot D, Vix M, Leroy J, Marescaux J. PerFix™ plug versus 4DDOME(®) implants for inguinal hernia repair: prospective multicentric randomised controlled trial. Hernia. 2012;16:561–6.CrossRefPubMedGoogle Scholar
  67. 67.
    Hirose T, Takayama Y, Komatsu S, Shingu Y, Sakamoto E, Norimizu S, Hasegawa H. Randomized clinical trial comparing lightweight or heavyweight mesh for mesh plug repair of primary inguinal hernia. Hernia. 2014;18:213–9.CrossRefPubMedGoogle Scholar
  68. 68.
    Efthimiou M, Symeonidis D, Koukoulis G, Tepetes K, Zacharoulis D, Tzovaras G. Open inguinal hernia repair with the use of a polyglycolic acid-trimethylene carbonate absorbable mesh: a pilot study. Hernia. 2011;215:181–4.CrossRefGoogle Scholar
  69. 69.
    Negro P, Gossetti F, Dassatti MR, Andreuccetti J, D'Amore L. Bioabsorbable Gore BIO-A plug and patch hernia repair in young adults. Hernia. 2012;16:121–2.CrossRefPubMedGoogle Scholar
  70. 70.
    Negro P, Campanelli G, Ipponi PL, Gossetti F, Dassatti MR, Manto O, D'Amore L. Selective use of bioabsorbable Gore BIO-A plug and patch for groin hernia repair. Hernia. 2013;17:795–6.CrossRefPubMedGoogle Scholar
  71. 71.
    Gossetti F, Massa S, Abbonante F, Calabria M, Ceci F, Viarengo MA, Manzi E, D’Amore L, Negro P. New “all-in-one” device for mesh plug hernioplasty: the Trabucco repair. Ann Ital Chir. 2015;86:570–4.PubMedGoogle Scholar
  72. 72.
    Kaafarani HM, Itani KM, Giobbie-Hurder A, Gleysteen JJ, McCarthy M Jr, Gibbs J, Neumayer L. Does surgeon frustration and satisfaction with the operation predict outcomes of open or laparoscopic inguinal hernia repair? J Am Coll Surg. 2005;200:677–83.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Francesco Gossetti
    • 1
    Email author
  • Linda D’Amore
    • 1
  • Maria Romana Grimaldi
    • 1
  • Francesca Ceci
    • 1
  • Paolo Negro
    • 1
  1. 1.Abdominal Wall Surgery Unit, Department of SurgerySapienza University of RomeRomeItaly

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