VERSIONE ITALIANA

P1010585a-300x254No more “plugs” or “patches”, but a dynamic prosthetic device that is placed without sutures or fixation. A surgical solution which respects the physiology of the inguinal region, combining an innovative method and improved comfort for the patient.

Inguinal hernia is a protrusion of abdominal viscera through the muscular wall of the inguinal region. It’s a common disease which yearly afflicts ca. 800,000 patients in USA. The treatment is surgical, with various techniques. As of now, these techniques aim to cover the inguinal area, one of most mobile areas in the human body, with static implants (meshes).

These prostheses are usually flat and are fixed in a variety of fashions to the muscles, do not cope with their movements yet create a stiff fibrotic reaction in tissues. This leads to stiffness and shrinkage of the implant, can cause discomfort and, in some cases, even chronic pain. The shrinkage of the implant can set free the hernia opening, which was previoulsy covered by the mesh. This is a prelude to hernia recurrence.

Today, as an alternative to conventional implants, we can use a device that promotes the re-growth of healthy tissue in the area of the hernia opening, establishing a condition similar to normal abdominal wall structures. Patients, normally get back home same day of the surgical procedure. The return to normal activities is possible starting from the first week after surgery. Diapositiva10

Until now, most scientific studies have focused on the effects of the hernia, rather than its origins. As a result, years of surgical practice have been carried out treating a disease without knowledge on its genesis.

Professor Amato’s studies, published in the most relevant journal on the hernia disease, led to new concepts about the origin of inguinal hernia. The Dynamic Implant was engineered following to these studies and their scientific outcomes.

The 3D dynamic implant do not covers, but  full thickness obliterates the muscular gap where the hernia arises. Moves in harmony with the inguinal structures promoting regeneration of new and vital tissue inside its structure and enabling a true barrier which definitely closes the hernia orifice.

The procedure

  • 100% “Tension free”: no fixation of the prosthesis with sutures, stitches, staples or similar.
  • Performed, in non-complex cases, under local anesthesia.
  • Patient usually is discharged same day of the surgical procedure.

Tissue regeneration following hernia repair procedure

The conventional static implants by the time shrink and form a regressive fibrotic scar plate which does not move in compliance with the groin structures but, hinders the kinetic of the inguinal region causing discomfort to the patients. Conversely, the dynamic implant contracts and relaxes in compliance with the muscular structures of the groin. Due to its continous movement, it acts as a scaffold for new tissue regeneration, creating a thick barrier of dense, viable and well vascularized tissue. The dynamic implant does not shrink, does not cause discomfort and its postoperative pain score results lower as the conventional hernia repair.

Biologic response: comparison between 3D dynamic implant and conventional meshes.

The difference of biologic response between the 3D dynamic implant and the conventional mesh is noteworthy. Conventional meshes after few weeks start to produce a fibrous, hard, irregular and inelastic scar that leads to shrinkage and surface reduction of the prosthesis.  This stiff scar plate, very similar to a foreign body reaction, rubbing on the inguinal floor can cause a frustrating discomfort, often complained by patients even after years from surgery. The hard plate typical of conventional prostheses is also reputed to be one of the causes of chronic pain, an event that can upset lives of patients.  To evaluate the differences in tissue incorporation between the two types of prosthesis, conventional static and 3D dynamic, Prof. Amato carried out a comparative scientific research on the biological response of the two implant types in the short, medium and long-term. This scientific experience demonstrated a manifest superiority in biologic response of the 3D dynamic prosthesis compared to conventional static meshes. The comparative scientific research demonstrated that over time the conventional flat mesh becomes a mixture of stiff scar amalgamated with amorphous plastic material. On the contrary, the 3D dynamic prosthesis is incorporated by a well-vascularized fleshy mass that fully overwhelm its fabric, which is no more recognizable.

Diapositiva3In the photo here on the side, the difference between the two prostheses few months postoperative is evident. The picture shows a biopsy of the 3D dynamic implant and a conventional static mesh explanted for recurrence. The structure of the 3D dynamic implant is no longer recognizable because incorporated by a well-vascularized fleshy tissue. The other picture shows an irregularly folded conventional static mesh turned into a hardened piece of scar plate. The difference is remarkable: living fleshy structure against a piece of hard cloth!

For those wishing to deepen the subject, the scientific article related to this research was published in the renowned international scientific journal Artificial Organs: “Biologic response of inguinal hernia prosthetics. A comparative study: conventional static meshes vs. 3D dynamic implants. 

Quality of regenerated tissue

  • After 6 months absence of inflammatory reaction
  • Presence of elastic fibers
  • Newly formed mature muscle fibers
  • Well-structured veins and arteries
  • Mature nerves
  • Fibro-adipous tissue
  • Soft and well hydrated connective

OTHER INNOVATIVE SOLUTIONS DEVELOPED BY PROF. AMATO FOR THE TREATMENT OF VENTRAL AND INCISIONAL HERNIAS

Prof. Amato also invented the tentacle shaped implant for the treatment of Diapositiva9abdominal wall hernias (incisional, umbilical and epigastric hernias). The related surgical technique allows a fixation free surgical procedure for the treatment of these widespread pathologies. Small skin incisions, minimized surgical trauma and sharply reduced postoperative complications are the highpoints of the surgical technique. This is possible thanks to the proprietary design of the prosthesis whose elongated straps, inserted through the abdominal wall, allow a definitive fixation free positioning of the implant, using the principle of tissue friction.

The modern prosthetic devices and the innovative surgical techniques developed by Prof. Amato have allowed a significant decrease of the postoperative complications. These techniques have been scientifically validated by numerous articles published in the most important scientific journals in the world.