WO2015059733A1

WO2015059733A1 - Prosthesis for repairing hernia

Info

Publication number: WO2015059733A1
Application number: PCT/JP2013/006218
Authority: WO
Inventors: 裕夫嵩原
Original assignee: 株式会社ニチオン
Priority date: 2013-10-21
Filing date: 2013-10-21
Publication date: 2015-04-30

Abstract

The present invention addresses the problem of providing a technique for sufficiently preventing relapse of hernia in the LPEC method wherein no wide-range incision is needed and effects of a placed prosthesis on a living body can be minimized. A prosthesis for repairing hernia characterized by comprising a mesh-type sheet that is formed into a hollow conical shape.

Description

Hernia repair prosthesis

The present invention relates to a prosthesis for repairing a hernia, and particularly to a prosthesis suitably used for repairing an inguinal hernia.

Conventionally, it is known that 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. . For example, in the vicinity of the groin, which is the base of the thigh of the human body, 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. Specifically, 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. In addition, 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.

Here, as a method of treating an abdominal hernia, 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.

Among these, the method of repairing hernia by incising the groin is generally used for treating adult abdominal hernia regardless of the type of hernia. In the method of repairing the hernia by incising the inguinal portion, the hernia sac PP (the portion of the peritoneum P protruding from the hernia gate) protruding from the hernia gate G (gap portion) is excised, and then the hernia gate G Reinforcement is performed.
Specifically, as 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.

However, in the direct suturing method, the muscles around the hernia gate are brought together by suturing, so there is a problem that the affected area feels a crispness, and the hernia may recur due to further weakening of the muscle around the hernia gate. There's a problem.

On the other hand, in the mesh method, as shown in FIG. 2, 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 In the structure, 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.
Note that 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. Alternatively, 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. And 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).

However, in 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.

In recent years, attention has been paid to a method of repairing a hernia by laparoscopic approach to the gap as a method capable of repairing the hernia without incising the cellular tissue around the inguinal region or the hernia gate G. Has been. Specifically, 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, such as the LPEC method, 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.

JP 2008-62077 A

However, 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.

Therefore, 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. We conducted intensive research. 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. By fixing the prosthesis to form scar tissue and adhering the inner peripheral surface of the hernia sac, it is possible to reinforce the closure of the hernia sac without affecting the peritoneum by the prosthesis or the scar tissue Inspired. Therefore, 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. Thus, 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. Therefore, when repairing a hernia using the LPEC method, after fixing the prosthesis to the distal end side of the hernia sac rather than the position to ligate the hernia sac, ligating the protruding peritoneal portion on the abdominal side of the prosthesis fixing position Reinforce hernia sac closure with a prosthesis without affecting the peritoneum and prevent hernia recurrence sufficiently.

Here, the hernia repair prosthesis of the present invention is preferably composed of a single-layer mesh sheet. In this way, by configuring the prosthesis with 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.

Further, 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.
In the hernia repair prosthesis of the present invention, the mesh sheet preferably has a wire diameter of 0.15 to 0.35 mm.
In this way, by setting the prosthesis to the above-described dimensions, the prosthesis can be fixed in a state in which the prosthesis is more closely attached to the inner peripheral surface of the hernia sac, so that the closure of the hernia sac can be more effectively reinforced.

The hernia repair prosthesis of the present invention preferably has a fixing mark. Thus, if 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.

According to 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.

It is a partial cross section figure which shows the state which the organ in the abdominal cavity deviated from the gap | interval part of an abdominal wall. It is a partial cross section figure which shows the state which applied the mesh method of the prior art example, and prevented the organ in the abdominal cavity from deviating from the hernia gate. It is a partial sectional view showing the state where the conventional LPEC method was applied and the organ in the abdominal cavity was prevented from deviating from the hernia gate. It is a figure for demonstrating the hernia repair method using the prosthesis for the hernia repair of this invention, (a) is a partial cross section figure which shows the state which fixed the prosthesis to the hernia sac, (b) is a prosthesis It is a fragmentary sectional view which shows the state which diameter-reduced the hernia sac after fixing, and (c) is a fragmentary sectional view which shows the state which ligated the hernia sac after diameter-reducing the hernia sac. 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.

Hereinafter, embodiments of the present invention will be described with reference to the drawings.
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. Specifically, 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.

<Description of hernia repair method>
First, an example of a novel 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. How to repair using
In addition, 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.

In this repair method, first, a laparoscopic hole for inserting a laparoscope for observing the hernia sac PP from the abdominal cavity AC inside the abdomen AR, ligation of the hernia sac PP, or movement of the prosthesis 2 in the abdominal cavity AC, etc. The operation means (for example, grasping forceps) for performing various operations in the abdominal cavity AC is formed with an operation hole for inserting into the abdominal cavity AC. For the laparoscopic hole, for example, 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. Specifically, 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. After puncturing an incision in the abdominal AR with a device (eg, trocar), the needle (trocar body) is removed from the outer tube (trocar sleeve) and placed with the outer tube (trocar sleeve) penetrating the abdomen AR. Can be formed. Further, 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.

Then, if necessary, the organ that has deviated from the abdominal cavity AC is returned by a known method. Thereafter, 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. When the prosthesis 2 is introduced into the abdominal cavity AC, the inner diameter of the gap G can be measured in advance. Specifically, 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. By measuring the inner diameter of the gap G in advance, the prosthesis 2 fixed inside the hernia sac PP can be appropriately sized with respect to the gap G.

Then, after the prosthesis 2 is disposed inside the hernia sac PP via the laparoscopic hole or the operation hole, the prosthesis 2 is fixed to the hernia sac PP (see FIG. 4A), and the prosthesis 2 The hernia sac PP is reduced in diameter together with the prosthesis 2 at a position where is fixed (see FIG. 4B). Here, 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. In addition, after fixing the prosthesis 2 with a suture thread, 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. Pass the thread 3. Then, after passing the suture thread 3 to the operating means, the distal end of 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. As described above, for example, as shown in FIG. 5, 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.

Furthermore, after reducing the diameter of the hernia sac PP together with the prosthesis 2, 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. Then, 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. Can be ligated and closed. The suturing for ligation of the hernia sac PP can be performed a plurality of times.
In addition, from the viewpoint of effectively closing the hernia gate, the ligation position of the hernia sac PP is preferably an opening on the abdominal cavity AC side of the gap G. In addition, from the viewpoint of effectively reinforcing the closure of the hernia sac PP, 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).

After closing the hernia sac PP, the laparoscope and the operation means are extracted from the abdominal cavity AC, and the laparoscope hole and the operation hole are closed. Before the laparoscope and the operation means are extracted from the abdominal cavity AC, 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 operation and effect of the above-described hernia repair method will be described.
According to this hernia repair method, 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.
Further, according to this hernia repair method, 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. In addition, since 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.

In the above repair method, the hernia repair prosthesis of the present invention described later can be suitably used as the prosthesis 2. In addition, 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.

<Description of hernia repair prosthesis>
Next, a prosthesis 5 that is an example of the hernia repair prosthesis of the present invention that can be suitably used in the above repair method will be described with reference to FIG.

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. As shown in FIG. 6, 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). On the right side, 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).

And the prosthesis 5 is comprised by the mesh-like sheet | seat of 1 layer or more (in the example of illustration, 1 layer mesh-like sheet | seat).
Specifically, 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.

As the mesh sheet, 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.

As shown in FIG. 6, the prosthesis 5 is provided with a fixing mark M for facilitating the fixation of the prosthesis 5 to the hernia sac PP. Specifically, 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. Further, on the outer peripheral surface 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. In the example shown in FIG. 6, as 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. May be only one or more marks around the one end side portion, or may be only marks extending from the apex of the cone toward the outer peripheral edge of the bottom surface.
Here, 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.

Here, actions and effects obtained when the above-described prosthesis 5 is used in the above-described novel hernia repair method will be described.
Since the prosthesis 5 has a hollow cone shape, 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. In particular, 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.

Further, 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). Therefore, when used in the above-described hernia repair method, 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.

Here, from the viewpoint of making the prosthesis 5 easy to fold and facilitating the insertion into the abdominal cavity AC through the laparoscopic hole or the operation hole, and improving the adhesion to the inner peripheral surface of the hernia sac PP The wire diameter of the mesh sheet is preferably 0.15 to 0.35 mm. When 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. In addition, if the wire diameter of the mesh sheet is 0.15 mm or more, the strength can be ensured.
For the same reason, the opening diameter of the mesh sheet is preferably 1.0 mm to 2.0 mm. 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.

Furthermore, since 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. . In particular, 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.

Here, from the viewpoint of improving the ease of fixing the prosthesis 5 to the hernia sac PP, 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.

Further, from the viewpoint of fixing the prosthesis 5 in a state in which the prosthesis 5 is in close contact with the inner peripheral surface of the hernia sac PP, so that the closure of the hernia sac PP can be more effectively reinforced, when the prosthesis 5 is 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.

As mentioned above, although embodiment of this invention was described with reference to drawings, the prosthesis for hernia repair of this invention is not limited to said example, A change can be added suitably.

Specifically, the prosthesis can have any shape as long as it has a hollow cone shape with a cavity inside. Specifically, 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. Further, the shape of the prosthesis may be a truncated cone. Furthermore, although 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.

Further, the prosthesis may be composed of a multilayer mesh sheet. However, from the viewpoint of suppressing the generation of reaction force when the hernia sac is contracted with the prosthesis, the viewpoint of adhesion to the inner peripheral surface of the hernia sac, and the insertion property into the abdominal cavity, the prosthesis is 1 It is preferable to comprise a layered mesh sheet.

Further, 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.

1 mesh 1a sheet-like mesh 1b mesh plug 2

prosthesis

3, 4 suture 5 hernia repair prosthesis 6 mesh-like sheet 7 cavity 8 one end 9 other end AC abdominal cavity AR abdominal AW abdominal wall BS body surface D length measured along the axial direction G gap (hernia gate)
IO Organ M Marking OG Opening P Peritoneum PP Protruding peritoneum (hernia sac)
W Maximum width measured along the direction perpendicular to the axial direction

Claims

A hernia repair prosthesis comprising a mesh-like sheet formed in a hollow cone shape.
2. The hernia repair prosthesis according to claim 1, wherein the prosthesis is a single-layer mesh sheet.
3. The maximum width measured along the direction orthogonal to the axial direction is 10 to 30 mm, and the length measured along the axial direction is 15 to 40 mm. Hernia repair prosthesis.
The hernia repair prosthesis according to any one of claims 1 to 3, further comprising a fixing mark.
The hernia repair prosthesis according to any one of claims 1 to 4, wherein the mesh sheet has a wire diameter of 0.15 to 0.35 mm.
The hernia repair prosthesis according to any one of claims 1 to 5, wherein the prosthesis is used by being inserted into the hernia sac from the abdominal cavity side.