ZenToks Publication

Chapter 23

The Prolene Hernia System Repair for Inguinal Hernia Repair: A Review

Abstract/Preface

Inguinal hernia repair ranks among the most frequently performed surgical procedures globally, with mesh-based tension-free techniques established as the standard of care due to their low recurrence rates and favorable postoperative outcomes. The Prolene Hernia System (PHS), introduced by Gilbert, features a bilayer polypropylene mesh designed to reinforce both the posterior preperitoneal space and the anterior inguinal floor via a single anterior approach. The theoretical benefits of the PHS include comprehensive coverage of the myopectineal orifice, a reduced risk of recurrence, minimal tissue tension, and enhanced biomechanical support. Numerous randomized controlled trials and observational studies have compared PHS with Lichtenstein repair and other mesh-based techniques. Current evidence indicates comparable recurrence rates, chronic pain outcomes, and complication profiles, with some studies suggesting shorter operative times and faster recovery with PHS. Despite the increasing popularity of laparoscopic and robotic approaches, PHS remains a valuable option for open repair, particularly in selected patients undergoing primary unilateral inguinal hernia repair. This chapter evaluates the Prolene Hernia System and compares it with the Lichtenstein and plug mesh repair techniques.