‘Plug Free’ Connector Placement Modification of a Bilayer Patch Device in Male Indirect Inguinal Hernioplasty

The bilayer patch device (Ethicon, Prolen Hernia System®) for inguinal hernia repair has a connector that acts as a ‚plug‘ in the internal inguinal ring. The position of this ‚plug‘ component may be responsible for higher incidence of chronic pain and intestinal damage. We assumed that changing the position of the connector of a bilayer patch device (PHS®) and placing it medially in Hesselbach triangle would contribute to lower incidence of chronic pain and would not result in intestinal damage, with good clinical outcome following indirect inguinal hernioplasty. This retrospective study included 73 patients with 76 indirect inguinal hernias, who underwent the procedure of modifying the position of the bilayer patch device in the 2005-2015 period. The mean age of the patients was 57 years. Three patients had early postoperative complications (3.95%), two of which had postoperative seroma and one had postoperative pain. Three patients (3.95%) had late postoperative complications. One patient (1.32%) had chronic pain. There was one recurrence (1.32%) and one patient (1.32%) needed the mesh removed due to discomfort. The ‘plug free’ position of the connector of a bilayer patch device in patients with indirect inguinal hernioplasty is a safe procedure with low rate of chronic pain, no intestinal damage, and standard low recurrence.