Mesh-tissue security

In addition to functional integration of the synthetic mesh into the surrounding tissue, the mesh-tissue interaction must remain secure to prevent dislodgement or shifting that could result in hernia recurrence. Under normal conditions, the mesh may be subjected to forces parallel (shear) or perpendicular to the mesh-tissue interface. The absorbable microgrips of ProGrip™ have shown improved shear and peel strength compared to common stapler or fibrin glue fixation. A recent alternative means of self-fixation in a pre-coated mesh showed more frequent dislocation compared to ProGrip™ under normal conditions of movement in an animal model after hernia repair. Displacement was similarly greater for alternative fixation methods in another animal model, testing explanted tissues under pressure.

In vivo fixation comparison

Porcine study, samples implanted for 4 or 8 weeks subjected to peel test. At both time points, ProGrip™ demonstrates superior peel strength compared to Bard 3DMax® light mesh with Tisseel® or SorbaTacks® fixation.

¹Gruber-Blum S, Riepl N, Brand J, Keibl C, et al.: A comparison of Progrip((R)) and Adhesix ((R)) self-adhering hernia meshes in an onlay model in the rat. Hernia 2014; 18: 761-9. doi:10.1007/s10029-014-1258-0.PMID:24797638
²Guerin G, Bourges X, Turquier F: Biomechanical evaluation of three fixation modalities for preperitoneal inguinal hernia repair: a 24-hour postoperative study in pigs. Med Devices (Auckl) 2014; 7: 437-44. doi:10.2147/MDER.S71035.PMID:25525396

Return to Normal Activities

As a further proxy for quality of life and pain experience, the time taken to return to normal activities is also often assessed^1,2. Depending on the demographics of the patient population, many may be unemployed or retired, and thus a return to work is a less consistent measure of patient experience. ProGrip™ is typically associated with a sooner return to normal activities (Figure 1).

Figure 1: Time to return to normal activities for different fixation

Without additional fixation, ProGrip™ patients returned to normal activities sooner (P<0.04,>², in a separate study, the proportion of patients returning to normal within one week of surgery was higher without additional fixation¹.

¹Erbella J, Erbella A: Laparoscopic Extraperitoneal Inguinal Hernia Repair Using a Novel Mesh with Self-Fixating Properties. Surgical Science 2013; 04: 289-291. doi:10.4236/ss.2013.46056
²Batabyal P, Haddad RL, Samra JS, Wickins S, et al.: Inguinal hernia repair with Parietex ProGrip mesh causes minimal discomfort and allows early return to normal activities. Am J Surg 2016; 211: 24-30. doi:10.1016/j.amjsurg.2015.04.019.PMID:26275920

Patient Satisfaction

Patients have expressed a high degree of satisfaction after their surgeries with over 90% reporting they are satisfied or very satisfied for open or laparoscopic procedures to repair both inguinal and ventral/incisional hernias^{1,2,3,4,5,6,7,8} (Figure 1). In one trial where patients with bilateral hernias were randomized for which side received ProGrip™ without additional fixation and polypropylene mesh with suture fixation on the other side, twice as many patients indicated a preference for the ProGrip™ side (Figure 2)⁹.

Figure 1: Patient satisfaction is high after use of ProGrip™ in hernia repair

Figure 2: ProGrip™ patient preference in bilateral inguinal hernia repair

N=89 patients with bilateral inguinal hernia, randomized to which side received ProGrip™ and which side received sutured mesh⁸

¹Ronka K, Vironen J, Kossi J, Hulmi T, et al.: Randomized Multicenter Trial Comparing Glue Fixation, Self-gripping Mesh, and Suture Fixation of Mesh in Lichtenstein Hernia Repair (FinnMesh Study). Ann Surg 2015; 262: 714-9; discussion 719-20. doi:10.1097/SLA.0000000000001458.PMID:26583657
²Sanders DL, Nienhuijs S, Ziprin P, Miserez M, et al.: Randomized clinical trial comparing self-gripping mesh with suture fixation of lightweight polypropylene mesh in open inguinal hernia repair. Br J Surg 2014; 101: 1373-82; discussion 1382. doi:10.1002/bjs.9598.PMID:25146918
³Birk D, Hess S, Garcia-Pardo C: Low recurrence rate and low chronic pain associated with inguinal hernia repair by laparoscopic placement of Parietex ProGrip mesh: clinical outcomes of 220 hernias with mean follow-up at 23 months. Hernia 2013; 17: 313-20. doi:10.1007/s10029-013-1053-3.PMID:23412779
⁴Hopson SB, Miller LE: Open ventral hernia repair using ProGrip self-gripping mesh. Int J Surg 2015; 23: 137-40. doi:10.1016/j.ijsu.2015.09.069.PMID:26433025
⁵Kosai N, Sutton PA, Evans J, Varghese J: Laparoscopic preperitoneal mesh repair using a novel self-adhesive mesh. J Minim Access Surg 2011; 7: 192-4. doi:10.4103/0972-9941.83514.PMID:22022105
⁶Luque JA, Luque AB, Menchero JG, Grau JM, et al.: Safety and effectiveness of self-adhesive mesh in laparoscopic ventral hernia repair using transabdominal preperitoneal route. Surg Endosc 2016; 10.1007/s00464-016-5094-4. doi:10.1007/s00464-016-5094-4.PMID:27444834
⁷Ozmen J, Choi V, Hepburn K, Hawkins W, et al.: Laparoscopic Totally Extraperitoneal Groin Hernia Repair Using a Self-Gripping Mesh: Clinical Results of 235 Primary and Recurrent Groin Hernias. J Laparoendosc Adv Surg Tech A 2015; 25: 915-9. doi:10.1089/lap.2015.0056.PMID:26523915
⁸Porrero JL, Castillo MJ, Perez-Zapata A, Alonso MT, et al.: Randomised clinical trial: conventional Lichtenstein vs. hernioplasty with self-adhesive mesh in bilateral inguinal hernia surgery. Hernia 2015; 19: 765-70. doi:10.1007/s10029-014-1316-7.PMID:25367200
⁹Mangram A, Oguntodu OF, Rodriguez F, Rassadi R, et al.: Preperitoneal surgery using a self-adhesive mesh for inguinal hernia repair. JSLS 2014; 18. doi:10.4293/JSLS.2014.00229.PMID:25587212

Surgeon Comments

Surgeons using ProGrip™ meshes have positively reviewed its self-gripping technology. Their use has been described as:

⇒ “Fast, simple, and economical”¹

⇒ A “reliable alternative for the treatment of inguinal hernia with benefits on operating time as well as on postoperative pain”²

⇒ Cost-effective, with the “increased costs [of ProGrip™ compared to pure polypropylene mesh] are compensated by the reduced utilization of the operating room.”³

⇒ “Reduc[ed] incidence of chronic pain, and costs of the procedure.”⁴

⇒ “SGM [self-gripping mesh, ProGrip™] during TAPP repair of inguinal hernias has become the standard”⁵

⇒ “In our opinion, this device permits a faster learning curve with less surgical skills needed to place the mesh and fix it [during laparoscopic repair]”⁶

⇒ In a multicenter study including surgeons from nine recruiting hospitals in Belgium, Germany, the Netherlands, Sweden and the United Kingdom6 operating on 270 patients, the handling of the mesh for open repair was described as good or very good by 96.7% of surgeons. In the laparoscopic arena, multiple publications describe simple handling techniques for the successful deployment of the mesh^7,8,9,10,11.

¹Klobusicky P, Feyerherd P: Innovation in Laparoscopic Inguinal Hernia Reparation - Initial Experiences with the Parietex Progrip Laparoscopic() - Mesh. Front Surg 2015; 2: 28. doi:10.3389/fsurg.2015.00028.PMID:26161386
²Gys T, Gys B, Lafullarde T: The Use of a Self-gripping Mesh in Open Inguinal Hernia Repair. A Prospective Observational Single Surgeon Study. Acta Chirurgica Belgica 2013; 113: 192. doi:10.1080/00015458.2013.11680910.PMID:24941715
³Kapischke M, Schulze H, Caliebe A: Self-fixating mesh for the Lichtenstein procedure--a prestudy. Langenbecks Arch Surg 2010; 395: 317-22. doi:10.1007/s00423-010-0597-2.PMID:20174819
⁴Piccinni G, De Luca GM, De Luca A, Giungato S, et al.: Mid-Term Follow Up of TAPP Hernia Repair Without Staples and Glue: An Audit of the Data. Surgical technology international 2015; 26: 151-154.PMID:26055003
⁵Fumagalli Romario U, Puccetti F, Elmore U, Massaron S, et al.: Self-gripping mesh versus staple fixation in laparoscopic inguinal hernia repair: a prospective comparison. Surg Endosc 2013; 27: 1798-802. doi:10.1007/s00464-012-2683-8.PMID:23292556
⁶Sanders DL, Nienhuijs S, Ziprin P, Miserez M, et al.: Randomized clinical trial comparing self-gripping mesh with suture fixation of lightweight polypropylene mesh in open inguinal hernia repair. Br J Surg 2014; 101: 1373-82; discussion 1382. doi:10.1002/bjs.9598.PMID:25146918
⁷Erbella J, Erbella A: Laparoscopic Extraperitoneal Inguinal Hernia Repair Using a Novel Mesh with Self-Fixating Properties. Surgical Science 2013; 04: 289-291. doi:10.4236/ss.2013.46056
⁸Wang Y, Zhang X: Short-term results of open inguinal hernia repair with self-gripping Parietex ProGrip mesh in China: A retrospective study of 90 cases. Asian J Surg 2015; 10.1016/j.asjsur.2015.05.001. doi:10.1016/j.asjsur.2015.05.001.PMID:26143593
⁹Lechner MN, Jager T, Buchner S, Kohler G, et al.: Rail or roll: a new, convenient and safe way to position self-gripping meshes in open inguinal hernia repair. Hernia 2016; 20: 417-22. doi:10.1007/s10029-015-1389-y.PMID:25989726
¹⁰Lerdsirisopon S, Kasetsermwiriya W, Tansawet A, Techapongsatorn S: Mini-totally extraperitoneal hernioplasty using progrip: The vajira crispy roll technique. Surgical Endoscopy and Other Interventional Techniques 2014; 28: S58.
11 Porrero JL, Cano-Valderrama O, Castillo MJ, Alonso MT: Proposed technique for inguinal hernia repair with self-gripping mesh: avoiding fixation to undesired structures. Hernia 2015; 19: 771-4. doi:10.1007/s10029-014-1315-8.PMID:25480125