I have been using 3DMax Bard for over 100 cases of direct,indirect and femoral hernia in both Tapp and Tep, I found it easy,faster to deploy,easy to orient and spread the mesh.Fixation was done in most of the cases,one point fixation to cooper's ligament/pubic tubercle.One year followup ,no recurrences. Size of the defect is mostly 3 to 4cms. Downside is the cost. Mostly light weight mesh was used.
I usually do not use any mechanical fixation in TAPP-repair (except L3-hernia). In bigger medial hernias it is - in most cases - enough to create a planation the medial compartment by an inverting suture-fixation of the prolapsing transverse fascia. Additionally I couldn´t find any data according to specific advantages by using 3-dimensional meshes (beside the surgeons comfort) - using a light-weight macropouros flat mesh (at least 10:15cm in size) is enough.
Expensive.
If you use 3D-Max, I am not sure it makes sense to fixate the mesh.
No fixation, only by big direct inguinal hernia.(3D-max). Great mesh, I allready use it >3 years.
A little gasoline on this lukewarm topic:
Could anyone enlighten me about the evidence to support using 3D-Max instead of just about any other mesh, especially the rationale to pay 3-4 times more? Unwiilingness (=laziness) to learn how to properly deploy a flat mesh, is OK for an answer...
:o)
In Belgium, the reimbursement price is the same for each prostesis. The company tries to stay unther this price.So, why use a mini if you can drive the rolls royce for the same money ?!!! It's very easy to place the 3D-max. I only use a two trocar procedure.
These are my very personal views on TEP meshes, not evidence based:
In order to achieve and maintain the dome shape of the 3D-Max and 3D-Max Light (and similar products), the mesh necessarily must have a certain rigidity. Similar to standard-weight meshes (Marlex, Prolene, etc), this stiffness simplifies the deployment of the mesh, but at the cost of a higher risk for the patient to experience a long-term foreign body sensation.
Which moves us on to the automobile metaphor:
- To me, TEP with 3D-Max is a high quality procedure, but not very exceptional; it's a Volvo.
- The top-of-the line TEP, the Rolls-Royce, includes a light-weight mesh, fixated with fibrin glue.
What I can conclude after each hernia congress or symposium. Each type of hernia-operation, each mesh is proven to be excellent. The problem is not the type of operation or the mesh. The problem is the man doing the operation, the surgeon !!! I do more than 200 TEP procedures each year and using the 3D MAX, to me it's the rolls royce. But to another surgeon, who's used to do other type of hernia-operation and/or using other type of mesh, he thinks he's doing his best and driving with a rolls royce. It's all surgeon related. We don't use glue, because it's not reimbursed in Belgium and thereby verry expensive. In our centrum , we have a recidiv ratio in inguinal hernia surgery of
Volvo vs Rolls-Royce:
When I conceived the idea to fixate mesh with fibrin glue (only) 15 years ago, it was never my intention to improve already very low recurrence rates.
Volvos are just as fast as RRs.
The rationale was to further lower the risk for chronic pain/discomfort. With the subsequent introduction of soft light-weight large-pore meshes, the use of fibrin glue fixation became even more advantageous.
Deploying a "flat" light-weight mesh and then meticulously glue it takes a little extra skill, and cost a little more.
Just like the making of RRs, that are more comfortable than Volvos.
We will recommend mesh free and tension free open repair in all cases to avoid dangers of a foreign body. Pl. visit www.desarda.com
