News Release

'Plug and patch' method of hernia repair an effective replacement for old surgical methods

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There is good news for the 750,000 people who will experience their first hernia this year. Surgeons are now using an innovative "plug and patch" method that takes about 30 minutes, does not require general anesthesia and allows patients to resume normal activities in two to three days.

"It costs less than some other hernia treatments, there is less pain, recovery time is reduced and the repair is more durable," said Dr. Keith Millikan, general surgeon at Rush-Presbyterian-St. Luke's Medical Center in Chicago. A hernia is a weakness or defect in the abdominal wall, especially near the groin, navel or near any previous surgical incisions. Men usually get this type of hernia while women tend to suffer from femoral hernias that occur at the top of the thigh, which occur during pregnancy and childbirth. Hernias may be present from birth or develop over a period of time. Typically, treatment involves surgery in which both sides of the hole are stitched together while the patient is under general anesthesia. Recovery can take months and is often accompanied by discomfort and reduced activity.

With the "plug and patch" method, surgeons make a two-inch incision near the groin area, and then cut away the underlying tissue to access the hole. While carefully avoiding crucial nerves and cauterizing minor blood vessels, a small white conical shaped plug that resembles a badminton birdie is inserted into the hole or hernia. The tapered shape of the plug eases insertion into the defect and fills the hole much like a cork in the neck of a bottle. The plug's umbrella shape allows it to expand and contract with the groin muscles to provide tension-free hernia repair, according to Millikan. The hole is then covered with a specially formulated, plastic mesh patch, which is placed over the entire groin area for reinforcement before the incision is sewn up. Total time for this surgery is often about 30 minutes and because the patient is on local anesthesia there is no grogginess to overcome.

"Most of my patients walk off the operating table and are ready to resume their normal activity in two to three days, " said Millikan. In addition to the time and recovery benefits, Millikan points out that the "plug and patch" method is less expensive than methods that require general anesthesia.

The mesh, polypropylene patch serves in much the same way as a lattice does with vines, allowing human tissue to grow through the patch. Eventually, the human tissue covers and envelopes the mesh patch, creating a strong tissue base that will more likely resist future rupture, Millikan said. He stressed that the use of the plug to fill the hernia eliminates much of the tension on the tissues once the hernia is repaired.

Plug and patch represents an improvement over existing hernia treatments for first-time hernia patients, Millikan said. In the laproscopic method of hernia repair, a surgical telescope is inserted through a small puncture in the abdominal wall and two additional narrow tubes are inserted through the abdominal wall to allow placement of surgical instruments. The hernia is identified and repaired by stapling a patch over the defect in the abdominal wall. This method often requires general anesthesia and involves a deeper surgical approach that extends into the abdominal cavity, according to Millikan. The alternative laproscopic method is also approximately twice as costly as the plug and patch method.

Earlier hernia repair methods, which are still used, involve stitching together the two sides of the hole. However, Millikan points out that this approach creates tension and is often the cause of the high hernia recurrence rate among men who are treated this way. "My mom learned that the best way to repair a hole in my jeans was not by sewing together the two sides, because this method eventually resulted in ripping. She found that by putting a patch over the hole, the jeans could be used for a longer period of time." The "plug and patch" repair for hernias works the same way.

In combination with the plug, this method eliminates much of the tension that occurs with the older method of hernia repair and reduces the hernia surgery recurrence rate from 15-20 percent to less than 1 percent, according to Millikan. "Now, about 30 percent of surgeons are using the "plug and patch" and I think you will see the number increase in the near future," he predicted. The materials used in the plug and patch method are manufactured by Davol Inc., a subsidiary of C.R. Bard, Inc in Cranston, R.I.

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Rush-Presbyterian-St. Luke's Medical Center includes the 809-bed Presbyterian-St. Luke's Hospital; 154-bed Johnston R. Bowman Health Center for the Elderly; Rush University (Rush Medical College, College of Nursing, College of Health Sciences and Graduate College); and seven Rush Institutes providing diagnosis, treatment and research into leading health problems. The medical center is the tertiary hub of the Rush System for Health, a comprehensive healthcare system capable of serving about three million people through its outpatient facilities and eight member hospitals


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