Transperitoneal view of the PROLENE hernia system open mesh repair.

The PROLENE Hernia System (PHS), consisting of an onlay and an underlay patch with a connector, has recently been introduced as an option for tension-free open repair of inguinal hernias and is touted for the repair of both direct and indirect hernias. In theory, the underlay is placed either through the internal ring or through the transversalis fascia and is seated in the preperitoneal space. To date, there have been no views of how this underlay is seated after open repair. Our objective was to determine the position and orientation of the underlay patch after open repair. After informed consent, two patients requiring both umbilical and inguinal hernia repairs had their inguinal hernias repaired using the open technique with the PHS. In the first patient, after open inguinal repair, the umbilical hernia was reduced, a 30 degrees laparoscope was placed intraperitoneally, and the underlay patch placed in the retroperitoneal space was visualized through the translucent peritoneum. In the second patient, the umbilical hernia was initially reduced, and the laparoscope was introduced to visualize the creation of the preperitoneal space and placement of the underlay during open repair of the inguinal hernia. As per our hypothesis, we show that the preperitoneal space is successfully created during open repair with the PHS with minimal trauma. More importantly, the underlay is deployed open and contours to the shape of the abdominal wall from the native intra-abdominal pressure, covering regions at risk for future herniation.