WO2015059733A1 - Prothèse destinée à la réparation d'une hernie - Google Patents

Prothèse destinée à la réparation d'une hernie Download PDF

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Publication number
WO2015059733A1
WO2015059733A1 PCT/JP2013/006218 JP2013006218W WO2015059733A1 WO 2015059733 A1 WO2015059733 A1 WO 2015059733A1 JP 2013006218 W JP2013006218 W JP 2013006218W WO 2015059733 A1 WO2015059733 A1 WO 2015059733A1
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WO
WIPO (PCT)
Prior art keywords
hernia
prosthesis
sac
mesh
abdominal cavity
Prior art date
Application number
PCT/JP2013/006218
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English (en)
Japanese (ja)
Inventor
裕夫 嵩原
Original Assignee
株式会社ニチオン
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Publication date
Application filed by 株式会社ニチオン filed Critical 株式会社ニチオン
Priority to PCT/JP2013/006218 priority Critical patent/WO2015059733A1/fr
Publication of WO2015059733A1 publication Critical patent/WO2015059733A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/0063—Implantable repair or support meshes, e.g. hernia meshes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/0057—Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/0057—Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect
    • A61B2017/00646—Type of implements
    • A61B2017/00659—Type of implements located only on one side of the opening
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/0057—Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect
    • A61B2017/00646—Type of implements
    • A61B2017/00663—Type of implements the implement being a suture
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0063—Three-dimensional shapes
    • A61F2230/0067—Three-dimensional shapes conical

Definitions

  • the present invention relates to a prosthesis for repairing a hernia, and particularly to a prosthesis suitably used for repairing an inguinal hernia.
  • a gap portion can be congenital or acquired in an abdominal wall forming an abdominal cavity in a living body. If the gap exists, organs in the abdominal cavity may protrude from the normal position to the body surface side through the gap (hernia gate) due to, for example, an increase in abdominal pressure, and hernia may develop. .
  • the gap IO exists near the groin, so that the organ IO in the abdominal cavity AC passes through the gap G as shown in FIG.
  • An abdominal hernia such as an outer inguinal hernia, an inner inguinal hernia or a femoral hernia may develop by protruding to the BS side.
  • a gap G is formed by the patency of peritoneal sheath-like projections that are normally closed with growth, or by the expansion of the inner inguinal ring of the inguinal heel due to fascia or abdominal muscle weakening. May develop hernia.
  • the gap G may be formed due to the weakening of the transverse muscle fascia of the inguinal heel and the thigh ring, which is a passage of blood vessels to the leg, and an internal inguinal hernia or femoral hernia may occur.
  • an inguinal portion is incised and approached to the gap from the operator side, and a hernia is repaired, and a gap is placed under the laparoscope without incising the inguinal portion.
  • Approaches and methods of repairing hernias are known.
  • the method of repairing hernia by incising the groin is generally used for treating adult abdominal hernia regardless of the type of hernia.
  • the hernia sac PP the portion of the peritoneum P protruding from the hernia gate
  • the hernia gate G (gap portion) is excised, and then the hernia gate G Reinforcement is performed.
  • a method of repairing hernia by incising the inguinal region for example, a method of bringing the fascia and muscle around the hernia gate G together and suturing (direct suture method), or indwelling in the human body
  • a method (mesh method) in which an artificial object (prosthesis) made of mesh is placed in the hernia gate is adopted, and the hernia gate G is reinforced by sewing or prosthesis.
  • the biocompatible mesh 1 made of polypropylene or the like as a prosthesis is fixed to the fascia around the hernia gate G with a suture thread, whereby the mesh 1
  • reinforcement of the hernia gate G is achieved by growing a cell tissue so as to be integrated with the mesh 1 to form a scar tissue. Therefore, according to the mesh method, the hernia recurrence rate can be improved as compared with the direct suture method.
  • the mesh 1 used in the mesh method is a sheet-like mesh 1a for covering the hernia gate G by being arranged on the outer side (body surface BS side) and / or the inner side (abdominal cavity AC side) of the hernia gate G.
  • a mesh plug 1b that is inserted into the hernia gate G and fixed to the preperitoneal space between the peritoneum P and the fascia around the hernia gate G is used.
  • the mesh plug 1b is equipped with the some mesh for maintaining the plug shape and increasing the bulk of the mesh plug itself in the inside (for example, refer patent document 1).
  • the mesh method when the mesh 1 is placed and fixed, the cellular tissue around the hernia G is incised extensively including the healthy part, and the cellular tissue is peeled off to surround the hernia G. Preventively reinforce a wider area than the lesion. Therefore, in the mesh method, when the mesh 1, particularly the mesh plug 1b as described in Patent Document 1, is moved in the surrounding tissue, or scar tissue is formed in the mesh 1 in an unfavorable manner, There is a possibility that the organ IO in the abdominal cavity AC is injured when 1 and the surrounding tissue adhere to each other in an undesirable manner. And when organ IO is injured, there exists a possibility that a complication may develop. Therefore, the mesh method has a problem that the hernia recurrence rate can be reduced, but it is necessary to reduce the influence on the living body in which the prosthesis is placed.
  • a laparoscope is inserted into the abdominal cavity AC of the patient's abdomen AR without incising the patient's body surface BS, and the hernia sac PP is ligated with sutures at the hernia gate G as shown in FIG.
  • a method of ligation and closing (laparoscopic percutaneous extraperitoneal closure, hereinafter referred to as “LPEC method”) has attracted attention.
  • the hernia repair method using a laparoscope differs from the direct suture method or mesh method in which a large incision is made from the body surface BS side to the structure of the inguinal canal where the external inguinal hernia develops. Since the hernia sac PP can be ligated with a suture without destroying the structure of the hernia sac, the structure of the inguinal fold around the hernia gate G is considered to be lovable.
  • the LPEC method using a laparoscope when the LPEC method using a laparoscope is applied to an abdominal hernia that has developed especially in an adult, the hernia portal G of the adult is large and the tissues such as fascia around the hernia G are hardened and weakened. Therefore, there is a risk that the hernia will recur if the hernia sac PP is simply tied by high ligation. Therefore, although the LPEC method can suppress the influence on a living body caused by a wide range of incisions and indwelling prostheses, it is difficult to permanently close the hernia sac PP when applied to an adult, for example. was there.
  • the present inventor does not need a wide incision, and in order to establish a technique that can sufficiently prevent hernia recurrence in the LPEC method that can reduce the influence on the living body caused by the indwelling prosthesis.
  • the inventor of the present invention has come up with the idea of reinforcing hernia sac closure in the LPEC method so that recurrence of the hernia can be sufficiently prevented even when applied to an adult, for example. Therefore, the present inventor has further studied, and in the LPEC method, the distal end side of the hernia sac (the side opposite to the abdominal cavity side) becomes a closed space rather than the position where the hernia sac is ligated at a high position.
  • the present inventor has further researched and found the shape of a prosthesis suitable for fixing to the distal end side of the hernia sac in the vicinity of the hernia gate and the position where high ligation is performed, and completed the present invention.
  • the hernia repair prosthesis of the present invention is characterized by comprising a mesh sheet formed in a hollow cone shape.
  • the prosthesis formed of a mesh-like sheet and formed in the shape of a hollow cone is composed of a peritoneum portion (hereinafter also referred to as “projection peritoneum portion”) protruding to the body surface side through the hernia gate. Easy to insert and fix under the laparoscope on the distal side of the hernia sac.
  • the hernia repair prosthesis of the present invention is preferably composed of a single-layer mesh sheet.
  • the prosthesis is easily crushed inside the hernia sac, and the closure of the hernia sac can be effectively reinforced.
  • the hernia repair prosthesis according to the present invention has a maximum width measured along the direction orthogonal to the axial direction of 10 to 30 mm and a length measured along the axial direction of 15 to 40 mm. Is preferred.
  • the mesh sheet preferably has a wire diameter of 0.15 to 0.35 mm.
  • the hernia repair prosthesis of the present invention preferably has a fixing mark.
  • the fixing mark is provided, the prosthesis can be fixed to the inside of the hernia sac reliably and easily.
  • the hernia repair prosthesis of the present invention can be used by being inserted into the hernia sac from the abdominal side.
  • the prosthesis for repairing a hernia of the present invention it is possible to provide a technique that can sufficiently prevent the recurrence of the hernia in the LPEC method that can reduce the influence on the living body.
  • FIG. 5 shows a cross-sectional view along the line aa in FIG. It is a perspective view which shows the prosthesis for the hernia repair of this invention.
  • the hernia repair prosthesis of the present invention is for preventing an organ in the abdominal cavity from deviating from the gap between the abdominal walls forming the abdominal cavity.
  • the hernia repair prosthesis of the present invention is for repairing a so-called hernia in which an organ in the abdominal cavity protrudes from the normal position to the surface of the body due to the presence of a gap in the abdominal wall. Can be used.
  • the hernia to be repaired is not limited, but, for example, abdominal hernias such as external inguinal hernias, internal inguinal hernias, and femoral hernias that develop near the inguinal region that is the base of the thigh of the human body. Is mentioned.
  • the hernia repair prosthesis of the present invention is characterized by comprising a mesh sheet formed in a hollow cone shape, and a protruding peritoneal portion (hernia) which is a part of the peritoneum protruding to the body surface side through a gap. It is fixed inside the sac.
  • hernia repair method using the hernia repair prosthesis of the present invention will be described with reference to FIG. Specifically, referring to FIG. 4, a hernia in which an organ IO in the abdominal cavity AC protrudes from the gap G of the abdominal wall AW forming the abdominal cavity AC to the body surface BS side is treated as a hernia repair prosthesis of the present invention.
  • the following hernia repairing methods can be used particularly suitably for mild or moderate hernias with a hernia gate composed of the gap G having a diameter of less than 30 mm.
  • the operation means for example, grasping forceps
  • the operation hole for inserting into the abdominal cavity AC is formed with an operation hole for inserting into the abdominal cavity AC.
  • the umbilicus of the abdominal part AR is incised into a size of about 3 to 10 mm, preferably about 3 to 5 mm, using a scalpel blade, and the incised place is punctured using a puncture device, for example. Can be formed.
  • the laparoscopic hole includes a needle that can be punctured into the abdominal cavity AC, and an outer tube that can be inserted into the laparoscope and that has a length that allows the tip of the needle to protrude in a combined state.
  • a device eg, trocar
  • the needle is removed from the outer tube (trocar sleeve) and placed with the outer tube (trocar sleeve) penetrating the abdomen AR.
  • the operation hole is formed as a laparoscopic hole, and then gas is injected from the laparoscopic hole so that the abdominal cavity pressure in the abdominal cavity AC is, for example, about 1 kPa. It can be formed by puncturing the abdomen AR using a simple puncture device.
  • the prosthesis 2 which is the prosthesis for repairing the hernia of the present invention is introduced into the abdominal cavity AC through the laparoscopic hole or the operation hole, and the prosthesis 2 from the abdominal cavity AC inside the hernia sac PP by the operation means. Deploy.
  • the inner diameter of the gap G can be measured in advance.
  • a measuring means for example, a suture having a predetermined length is placed inside the gap G, and the size of the measuring means is compared with the size of the gap G while observing with a laparoscope.
  • the inner diameter of the part G can be measured.
  • the fixation of the prosthesis 2 to the hernia sac PP and the diameter reduction of the hernia sac PP can be performed by fixing the prosthesis 2 to the hernia sac PP with the suture 3 and strongly binding the suture 3.
  • the diameter of the hernia sac PP can be reduced with a suture thread 3 different from the suture thread.
  • the prosthesis 2 can be sutured to the hernia sac PP using any means, but a needle that can be punctured while grasping the suture while observing from the abdominal cavity AC with a laparoscope. Can be performed by using a suture needle such as a suture passer and an operating means located in the abdominal cavity AC. Specifically, the tip of the suturing needle is introduced from the body surface BS side while holding the suture thread 3, pierced through the hernia sac PP, and sutured to the operating means (for example, grasping forceps) through the prosthesis 2.
  • the operating means for example, grasping forceps
  • the suture needle from which the suture thread 3 has been released is pulled out of the hernia sac PP and moved by moving the outer periphery of the hernia sac PP in the circumferential direction. Thereafter, the suture needle thus moved is used to puncture the hernia sac PP at a position different from the previous position, and the suture thread 3 is transferred from the operating means to the suture needle.
  • the hernia sac PP and the prosthesis 2 are sutured over the outer periphery thereof, and then the tip of the suture 3 is placed on the body surface BS side.
  • the prosthesis 2 can be fixed to the hernia sac PP by taking out and combining the front end side and the rear end side of the suture thread 3. Further, when the distal end side and the rear end side of the suture thread 3 are tied together, the hernia sac PP can be reduced in diameter together with the prosthesis 2 by tightly binding the suture thread 3. At this stage, the hernia sac PP may be slightly opened without being blocked after the hernia sac PP is reduced in diameter. Moreover, how the suture thread 3 passes through the hernia sac PP and the prosthesis 2 is not limited to the method of FIG. 5 and can be arbitrarily changed. Furthermore, the suture for fixing the prosthesis 2 and reducing the diameter of the hernia sac PP can be performed a plurality of times.
  • the hernia sac PP is sutured and ligated at a position inside the abdominal cavity AC from the fixed position of the prosthesis 2 (see FIG. 5C).
  • the ligation of the hernia sac PP can be performed using a known method used in the conventional LPEC method, for example, using a suture needle and operation means while observing from the abdominal cavity AC with a laparoscope Can be done. Specifically, the distal end of the suture needle is introduced from the body surface BS side with the suture thread 4 held, and the outer circumference of the hernia sac PP on the abdominal cavity AC side of the prosthesis 2 is moved to one side in the circumferential direction.
  • the hernia sac PP is pierced and the suture 4 is passed to the operating means (for example, grasping forceps). Then, the tip of the suture needle from which the suture thread 4 has been released is pulled back out of the hernia sac PP, and the outer periphery of the hernia sac PP is moved to the other side in the circumferential direction.
  • the suture thread 4 is passed through the operating means to the suturing needle. After passing the suture thread 4 over the outer periphery of the hernia sac PP, the distal end of the suture thread 4 is put out on the body surface BS side, and the distal end side and the rear end side of the suture thread 4 are tied together and tied tightly.
  • the suturing for ligation of the hernia sac PP can be performed a plurality of times.
  • the ligation position of the hernia sac PP is preferably an opening on the abdominal cavity AC side of the gap G.
  • the prosthesis 2 is fixed to the hernia sac PP more than the position where the hernia sac PP is ligated and closed. The position is preferably 5 to 10 mm moved to the opposite side).
  • the laparoscope and the operation means are extracted from the abdominal cavity AC, and the laparoscope hole and the operation hole are closed.
  • observation with a laparoscope is performed, and if another hernia sac PP exists in the abdominal cavity AC, the hernia sac PP can be ligated and closed. .
  • the hernia sac PP is used without greatly incising the body surface BS by using the suture needle introduced from the body surface BS side and the operation means inserted into the abdominal cavity AC while using the laparoscope. Since the hernia is repaired without damaging the cellular tissue structure around the gap G, the organ IO in the abdominal cavity AC is prevented from deviating from the gap G. Can do. That is, the hernia can be repaired without destroying the cell tissue structure as compared with the direct suture method or the conventional mesh method. Therefore, there is little physical burden on the patient, and early recovery and discharge can be realized.
  • the hernia sac PP when the hernia sac PP is ligated and closed with a suture, the prosthesis 2 is fixed to the hernia sac PP, and the prosthesis 2 is fixed and the inner peripheral surface of the hernia sac PP is fixed. Because of the close contact, scar tissue can be formed so as to be integrated with the prosthesis 2 in the hernia sac PP. Therefore, since the scar tissue effectively adheres to the inner peripheral surface of the hernia sac PP, the closure of the hernia sac PP is reinforced compared to the case where the prosthesis 2 is not used (that is, the conventional general LPEC method). can do.
  • the scar tissue is smaller than the conventional mesh method and the scar tissue is formed in a closed space of the hernia sac PP, an abdominal cavity AC using a mesh plug or the like that may occur when the conventional mesh method is adopted.
  • the possibility of damage to the internal organ IO can be reduced. Therefore, according to this repair method, the organ IO in the abdominal cavity AC is sufficiently prevented from deviating again from the gap G of the abdominal wall AW forming the abdominal cavity AC while reducing the influence on the living body due to the placement of the prosthesis 2. can do.
  • This repair method can be applied regardless of the size of the gap G. From the viewpoint of effectively preventing the organ IO in the abdominal cavity AC from deviating, the gap having a diameter of less than 30 mm is used. It is preferable to apply when G.
  • the hernia repair prosthesis of the present invention described later can be suitably used as the prosthesis 2.
  • the above repair method can be used regardless of the age of the patient, and can be applied not only to the human body but also to animals.
  • the prosthesis 5 which is an example of the hernia repair prosthesis of the present invention is configured by a mesh-like sheet having biocompatibility.
  • the prosthesis 5 has a cone shape having a cavity 7 inside the prosthesis 5 (that is, a hollow cone shape), in other words, one end 8 side in the axial direction (in FIG. 6).
  • the cross-sectional area orthogonal to the axial direction is larger than the cross-sectional area on the other axial end 9 side (left side in FIG. 6).
  • the prosthesis 5 is comprised by the mesh-like sheet
  • the prosthesis 5 is formed by bending a single mesh sheet into a conical shape, and using a biocompatible thread (for example, a suture thread) to bind and overlap the overlapping portions of the mesh sheet. By doing so or by heat-sealing the overlapped portion, it is formed in a hollow cone shape.
  • a biocompatible thread for example, a suture thread
  • a biocompatible material for example, a mesh sheet made of polyethylene, polypropylene or a mixture thereof, or a mesh formed by coating a mesh member made of such resin with, for example, titanium or the like.
  • a sheet can be used.
  • the prosthesis 5 is provided with a fixing mark M for facilitating the fixation of the prosthesis 5 to the hernia sac PP.
  • a fixing mark M for facilitating the fixation of the prosthesis 5 to the hernia sac PP.
  • one or more (four in the illustrated example) marks M are provided around one end side portion on the axial one end 8 side of the prosthesis 5.
  • a mark M extending from the apex of the cone toward the outer peripheral edge of the bottom surface is also provided.
  • the mark M both one or more marks around the one end side portion and a mark extending from the apex of the cone toward the outer peripheral edge of the bottom surface are provided.
  • the mark M may be formed by coloring the mesh sheet, or a thread having a color different from that of the mesh sheet and having biocompatibility (for example, a suture thread). You may form by tying and fixing to a mesh-like sheet. As described above, when forming a hollow cone-shaped prosthesis by bending the mesh sheet and fixing with a biocompatible thread, the thread used for fixing the mesh sheet is mesh-shaped. By using a thread having a color different from that of the sheet, the fixing thread can also function as the mark M. Thus, if the fixing thread functions as the mark M, the mark M can be provided at a low cost using a simple configuration.
  • the prosthesis 5 has a hollow cone shape
  • the prosthesis 5 when used in the above-described novel hernia repair method, the prosthesis 5 is moved from the inner side of the abdominal cavity AC to the inner side of the hernia sac PP even in a narrow space in the abdominal cavity AC. Can be easily inserted and arranged.
  • the hollow cone-shaped prosthesis 5 can be moved while being held from the inner peripheral surface side using an operation means such as a grasping forceps, and the hernia gate can be moved from the other axial end 9 side having a small cross-sectional area. And can be easily inserted into the hernia sac PP.
  • the prosthesis 5 since the prosthesis 5 is formed of a mesh sheet, the prosthesis 5 can be easily sutured to the hernia sac PP. Further, since the prosthesis 5 is hollow, it can be easily inserted into the abdominal cavity AC through a laparoscopic hole or an operation hole in a small folded state. Furthermore, the hollow prosthesis 5 does not generate excessive reaction force due to deformation of the prosthesis 5 when the hernia sac PP is reduced in diameter together with the prosthesis as shown in FIGS. 4 (a) to 4 (b).
  • the hernia sac PP and the prosthesis 5 can be brought into close contact with the prosthesis 5 in a state of matching the shape of the inner peripheral surface of the hernia sac PP. Furthermore, since the prosthesis 5 is a biocompatible mesh sheet, cells can form scar tissue densely with respect to the prosthesis 5 using the mesh structure as a scaffold. Therefore, the inner peripheral surface of the hernia sac PP can be effectively adhered.
  • the prosthesis 5 has a shape that does not have a cavity 7 inside, for example, a mesh plug shape as described in Patent Document 1 described above (a plurality of meshes that reinforce the plug shape and increase the bulk of the mesh plug itself. If it is made a solid structure), it cannot be folded small, and it becomes difficult to insert it into the abdominal cavity AC from the laparoscopic hole or the operation hole. In addition, when the prosthesis 5 has a solid structure, it becomes difficult to suture the prosthesis 5 to the hernia sac PP, and when the hernia sac PP is reduced in diameter, an excessive reaction force is generated due to the presence of an internal mesh. It becomes difficult to close the inner peripheral surface of the sac PP.
  • the wire diameter of the mesh sheet is preferably 0.15 to 0.35 mm.
  • the wire diameter of the mesh sheet is set to 0.35 mm or less, the bending rigidity of the mesh sheet is reduced, the folding is facilitated, and the adhesion to the inner peripheral surface of the hernia sac PP is increased.
  • the wire diameter of the mesh sheet is 0.15 mm or more, the strength can be ensured.
  • the opening diameter of the mesh sheet is preferably 1.0 mm to 2.0 mm.
  • the opening diameter of the mesh sheet When the opening diameter of the mesh sheet is set to 1.0 mm or more, the bending rigidity of the mesh sheet is reduced, the folding becomes easy, and the adhesion to the inner peripheral surface of the hernia sac PP is increased. In addition, if the opening diameter of the mesh sheet is 2.0 mm or less, the strength can be ensured.
  • the prosthesis 5 described above has the mark M, when the prosthesis 5 is sutured and fixed to the hernia sac PP, the position to be sutured can be easily confirmed using a laparoscope. .
  • the prosthesis 5 is hollow, and when it is placed in the hernia sac PP, the prosthesis 5 is crushed and the inner peripheral surfaces of the prosthesis 5 are in contact with each other. If provided, the prosthesis 5 can be fixed to the hernia sac PP at an appropriate position.
  • the prosthesis 5 may be provided with a reinforcing member that holds the shape of the prosthesis 5 until it is installed in the hernia sac PP. If the reinforcing member is provided, for example, even when the prosthesis 5 is folded into the abdominal cavity AC, the collapsed state can be quickly eliminated after the prosthesis 5 is introduced into the abdominal cavity AC. Therefore, when the prosthesis 5 is installed in the hernia sac PP, it is possible to prevent an appropriate suture position from becoming difficult to grasp due to contact between the inner peripheral surfaces of the prosthesis 5 or the like.
  • the reinforcing member is not limited as long as it has biocompatibility and does not exhibit a large reaction force that prevents the diameter reduction of the hernia sac PP. For example, a ring-shaped member Can be used.
  • the prosthesis 5 is preferably sized according to the diameter. Therefore, it is preferable that the prosthesis 5 has a maximum width W measured along the direction orthogonal to the axial direction of 10 to 30 mm, and a length D measured along the axial direction of 15 to 40 mm. In the illustrated example, one end 8 in the axial direction has a maximum width W.
  • the prosthesis can have any shape as long as it has a hollow cone shape with a cavity inside.
  • the shape of the prosthesis may be a cone (cone shape) as shown in FIG. 6, a polygonal pyramid such as a triangular pyramid, a quadrangular pyramid, or an elliptical pyramid.
  • the shape of the prosthesis may be a truncated cone.
  • the prosthesis 5 shown in FIG. 6 is open only at one axial end 8 side, the prosthesis may be open at the other axial end.
  • the prosthesis may be composed of a multilayer mesh sheet.
  • the prosthesis is 1 It is preferable to comprise a layered mesh sheet.
  • the prosthesis may be formed into a cone shape by integral molding, but from the viewpoint of cost and compatibility with a living body, one mesh sheet is bent into a conical shape, and a suture thread or the like is used. It is preferable to form a cone by fixing them.
  • the prosthesis for repairing a hernia of the present invention it is possible to provide a technique that can sufficiently prevent the recurrence of the hernia in the LPEC method that can reduce the influence on the living body.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Public Health (AREA)
  • Cardiology (AREA)
  • Veterinary Medicine (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Surgery (AREA)
  • General Health & Medical Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • Molecular Biology (AREA)
  • Medical Informatics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Transplantation (AREA)
  • Vascular Medicine (AREA)
  • Prostheses (AREA)

Abstract

La présente invention vise à fournir une technique destinée à suffisamment prévenir la récidive d'une hernie dans le procédé de fermeture laparoscopique percutanée extrapéritonéale (LPEC) n'impliquant aucune incision importante et permettant de minimiser les effets d'une prothèse mise en place sur un corps vivant. La présente invention concerne une prothèse de réparation de hernie caractérisée en ce qu'elle comprend une feuille de type treillis qui est mise sous une forme conique creuse.
PCT/JP2013/006218 2013-10-21 2013-10-21 Prothèse destinée à la réparation d'une hernie WO2015059733A1 (fr)

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PCT/JP2013/006218 WO2015059733A1 (fr) 2013-10-21 2013-10-21 Prothèse destinée à la réparation d'une hernie

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PCT/JP2013/006218 WO2015059733A1 (fr) 2013-10-21 2013-10-21 Prothèse destinée à la réparation d'une hernie

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Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN106562836A (zh) * 2016-04-06 2017-04-19 潘乃梁 一种用于腹腔镜补片植入术治疗***的疝气补片

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CN106562836A (zh) * 2016-04-06 2017-04-19 潘乃梁 一种用于腹腔镜补片植入术治疗***的疝气补片

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