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Surgeons who attended the October meeting of the American College of Surgeons in San Francisco gathered to watch the technique of hernia repair developed at the Hernia Institute of Florida. Dr. Arthur Gilbert, founder of the Institute and developer of the technique, moderated live transmissions of hernia repair before a theater of 400 surgeons on two of the days.

The Prolene Hernia System is a one-piece bi-layer mesh device that was developed by Ethicon, a Johnson and Johnson subsidiary, with the assistance of Dr. Arthur Gilbert of the Hernia Institute in South Miami. The surgeons at the Hernia Institute are among only thirty in the world whose practice is devoted to the repair of abdominal wall hernias. In the four years of its use as HIF, the Prolene Hernia System has been used to cure more than 3500 patients of annoying or incapacitating hernias, with less than 1/2 % recurrences. Of those repaired with PHS, 30% were recurrent hernias having broken down after being repaired elsewhere! In addition to inguinal hernias, the technique is now being used to repair many umbilical, epigastric, femoral, incisional, and spigelian hernias.

For the past twenty years surgeons have been using mesh reinforcement to try to decrease the number of recurrences (10-15%) that were found after the classic tight suture repairs. Initially the mesh was used to bolster the defect after suture repairs, so there was still a lot of tension, This increased the postoperative pain, and there were still an unacceptable number of recurrences. Dr. Gilbert’s idea used the latest concept of a “tension-free repair” in which the mesh actually fills the hole without tight sutures. Dr. Young states: “The Prolene Hernia System is a three-in-one device that literally does a triple repair, behind, through, and in front of the hole in the abdominal wall – it is a true physiologic repair since the posterior patch is secured in place against the inside of the abdominal wall by the patients own intra-abdominal pressure – the same forces that created the hernia are used to repair it!

The experience of the Prolene Hernia System technique used at the Hernia Institute has stimulated surgeons nationwide to sign up for seminars that the institute surgeons, Dr. Gilbert, Young, and Graham give periodically at South Miami Hospital. Last year nine groups collectively numbering 216 surgeons came for training programs consisting of a series of lectures followed by video broadcasts of live surgery. This year, between 15-25 post-graduate training courses will be scheduled, targeting about 500 surgeons. Dr. Young states: “Performing the surgery for live video broadcasts requires a higher level of expertise to be able to demonstrate the anatomy and the methodology of the Prolene System technique. This is not rehearsed or edited – it is real time – and you have to be prepared to make adjustments as you go along. The quality of the surgery done at the Institute is what keeps these other surgeons coming to learn the techniques that are available to our patients.”

Numerous international groups have also benefited by the programs. Via the media services of South Miami Hospital, under the able leadership of Mr. George Lakis, transmissions of live surgery have been beamed to Brazil, Chile, Argentina, Mexico, Germany, Paris, London, and India.

The Hernia Institute of Florida is preeminent in this specialty, locally, nationally, and internationally, and remains the treatment facility of choice for patients who need surgery for abdominal wall hernias. More abdominal wall hernias are done at HIF than at any other location in the United States. There is a difference!



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