Device and method for tacking a prosthetic screen

Abstract

A prosthetic screen tacking device includes a barbed filament with a perpendicular foot at one end and a swaged needle at the other. The barbs are situated near the foot and angulated in such a manner that they permit movement of the device through tissue in one direction (toward the needle), but prevent movement in the opposite direction (toward the foot). Methods of using the device and an improved barb are also disclosed.

Description

[0001] This application is a continuation-in-part of co-pending application Ser. No. 10 / 636,841, filed Aug. 7, 2003, the complete disclosure of which is hereby incorporated by reference herein.BACKGROUND OF THE INVENTION [0002] 1. Field of the Invention [0003] The invention relates to a device and method which simplifies the attachment of a prosthetic screen to the abdominal wall during the repair of abdominal wall hernias. [0004] 2. Brief Description of the Prior Art [0005] The layer or layers of fascia which lie in the abdominal wall and surround the peritoneal cavity are the strong structures which maintain the integrity of the peritoneal cavity. If there is a defect in the fascia, abdominal contents may penetrate weaker layers of the abdominal wall (comprised of muscle or fat) and push ahead the abdominal cavity's thin lining (peritoneum) so that abdominal contents, such as omentum or bowel, within their envelope of peritoneum, become situated in a subcutaneous position, often c...

AI Technical Summary

Benefits of technology

[0026] Using the open method of hernia repair, several tacking devices are pulled through the prosthetic screen equidistantly along the periphery (circumference) of the prosthesis. The assembly is then positioned within the open abdominal cavity, over the viscera. The swaged needles are individually passed through the abdominal wall at a point opposing the location where one tacking device penetrates the prosthesis, a point substantially beyond the edge of the fascial defect. The needles are separated from the filaments and the filaments are held in place with clamps. Each device is then pulled further through the abdominal wall by grabbing the filament and pulling upward. The devices are pulled as far as possible using appropriate force to draw the prosthesis against the abdominal wall. This action draws the barbs into the abdominal wall and through at least one fascial layer. The skin, where penetrated by the device, is simultaneously pressed downward, further compressing the abdominal wall, and the filament is severed at skin level. Pressure is released, the abdominal wall expands and the severed end of the filament recedes beneath the skin. The barbs on the remaining portion of the filament prevent dislodgement of the device which prevents the prosthesis from pulling away from the abdominal wall. The abdominal wound above the prosthesis is closed as completely as possible by standard technique, and the operation is concluded.

[0036] Another advantage of both embodiments is that, unlike a transmural suture, this device will not produce cosmetically undesirable dimpling of the skin.

Problems solved by technology

If there is a defect in the fascia, abdominal contents may penetrate weaker layers of the abdominal wall (comprised of muscle or fat) and push ahead the abdominal cavity's thin lining (peritoneum) so that abdominal contents, such as omentum or bowel, within their envelope of peritoneum, become situated in a subcutaneous position, often causing a visible bulge.

Viscera being squeezed through a facial defect can cause pain.

This may lead to infection and death if not surgically repaired.

This is relatively easy to do, but the repair has a high rate of failure because the sutured prosthesis often pulls away from the fascial edge.

However, materials such as Gortex™ or polypropylene mesh used for prosthetic screens are soft and may buckle and deform outside the suture line, so that the structural advantage of the overlap with fascia is not realized.

However, it can be difficult to secure an overlapping intraperitoneal prosthesis at its periphery when performing surgery using a conventional approach.

Access to the inside surface of the abdominal wall overlying the periphery of the prosthesis is limited.

The more the overlap, the more difficult the access.

Despite the many advances made in laparoscopic suturing techniques as well as in open hernia repair, there are still many problems to be overcome.

One problem is that in order to secure the prosthesis to the abdominal wall at a single point with a transmural suture, each suture end must be pulled separately through the abdominal wall.

This is time consuming.

Another problem is that after placement of both ends of each suture through the abdominal wall, they must be clamped together above the body wall while other transmural sutures are placed, because it is much easier to place transmural sutures before the prosthesis is cinched up against the abdominal wall.

A large number of clamps clutters the operative field and the sutures and clamps tend to entangle one another.

This process is somewhat time consuming and the multiple skin incisions produces a poor cosmetic result.

This often produces postoperative pain and cosmetically undesirable dimpling of the skin at the ligature sites.

The tacking device remains in place because the loop impedes accidental withdrawal from the abdominal wall.

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