ULTRAPRO® Hernia System: Toward an Ideal Solution? The Bonheiden Experience with a Partially Absorbable and Macroporous Bilayer Device

Abstract

In 1998, Gilbert introduced the Prolene Hernia System (PHS), a bilayer polypropylene mesh device composed of an onlay patch, a connector, and an underlay patch. The overall concept of its design was to include the best features of all currently available techniques while eliminating their undesirable features. This device is now available in a lightweight version, the Ultrapro® Hernia System (UHS; Johnson & Johnson, Somerville, NJ). We present the Bonheiden experience. From 2006 until 2009, we used 890 UHS devices in 712 patients. All patients were requested to join a prospective analysis with follow-up at one week and one month. Follow-ups at one and two years were organized using a telephone questionnaire. We were able to monitor 668 UHS implants in 526 patients. Bilateral primary hernias were repaired simultaneously in 142 patients and 6 hernias were a recurrence of a previous nonmesh repair. There were 472 men and 54 women in our cohort, with an average age of 57.5 years and average BMI of 24.79. No recurrences have occurred to date. Superficial wound infection presented in 3 patients. They were treated with antibiotics and no mesh needed to be removed. Seromas are much more common after this bilayer technique and are not considered a true complication. Whereas ecchymosis is very common, large hematomas were seen in 5 patients. One patient presented with a DVT of the iliac vein. She was treated with anticoagulation for three months, stockings, and early mobilization. The Ultrapro Hernia System is a good alternative to other preperitoneal hernia repairs, feasible in a day hospital under locoregional or general anesthesia. It has a very low recurrence rate but carries a more extensive dissection. We think the price paid for this extensive dissection is more than acceptable and is comparable to the Lichtenstein experience.