they work well but have their drawbacks . the ideal prosthetic material for hernia repair should be inexpensive to produce , easy to use , promote host tissue ingrowth , result in a healed repair with equal strength to normal tissue over extended periods of time , provide resistance to infection , elicit little or no inflammatory response , and inhibit adhesion or fistula formation . sis mesh is a new material that initially was used as a graft material for arteries , veins , ligaments , dura , wound coverage , and urinary bladders . the purpose of this research was to evaluate the short - term results of laparoscopic inguinal hernia repair with porcine small intestinal submucosa . patients were seen and interviewed because of a suspected inguinal hernia . if a hernia was confirmed after a history and physical examination , patients were asked to participate in this investigation of a new type of mesh to repair their inguinal hernia . patients were excluded from participating in the study if their hernias extended into the scrotum or were larger than 4 centimeters in size . the first 12 patients to agree to have surgery are included in this preliminary study . the first patient underwent hernia repair on august 19 , 1999 and the last patient on november 6 , 2000 . laparoscopic hernia repair was performed with a totally extraperitoneal technique ( tepp ) in 11 of 12 patients . a balloon was used to dissect the peritoneum away from the anterior abdominal wall down to below the pubic bone . an 11-mm hasson cannula was used in the fascia , just lateral to the umbilicus on the same side as the hernia . two 5-mm cannulas were used in the midline above the pubic bone and midway between the umbilicus and pubis . the mesh , measuring 7 x 10 centimeters , was placed , uncut , over the myopectinate orifice . five tacks were placed into the mesh into pubic bone ( cooper 's ligament ) in the midline , lacunar ligament and superiorly in the transversalis fascia . one patient was treated with a transabdominal preperitoneal repair ( tapp ) because the hernia was incarcerated and could not be reduced before surgery . patients were seen postoperatively at 2 weeks , 6 weeks , 3 months , and 6 months . over 600 laparoscopic inguinal hernia repairs have been performed at the gallbladder & laparoscopic surgery center since 1992 . patients in the sis group were matched to patients operated upon at the same time and dates . the patients in the control group had the same preperitoneal laparoscopic hernia repair except a polypropylene mesh was used for the repair . mesh was placed uncut over the myopectinate space and tacked to the cooper 's ligament , inferiorly , and to the transversalis fascia , superiorly . a 15 x 15-cm mesh was used and then cut down to a slightly smaller size if the patient 's weight , body habitus , and hernia defect required a smaller than 15 x 15-cm mesh size . anesthetic techniques included general endotracheal in 6 patients , laryngeal mask with local infiltration of 30 cc of 1/2% bupivacaine in 5 patients , and epidural in 1 patient . operative findings were direct hernias in 2 , indirect hernias in 12 , and a pantaloon hernia in 1 patient . three patients had a seroma ( 25% ) and all resolved . in 2 of those patients ( 15% ) , the use of mesh to repair inguinal hernias is now accepted as the standard of care by many surgeons whether the repair is performed openly or laparoscopically . recurrence rates are low when mesh is used and are reported to be between 3% and 6% for laparoscopic herniorrhaphy . the goal of hernia repair is to relieve the discomfort and to prevent the strangulation of intestine through the reconstruction of the inguinal floor . the fact that so many types of hernia repairs are described in the literature speaks to the fact of the difficulty in achieving this goal . laparoscopic hernia surgery has been shown to have a short hospital stay , cause minimal pain , and offer improved convalescence . small intestinal submucosa ( sis ) was first investigated as a vascular graft substitute in dogs in 1989 . the uses of sis have exploded over the past few years and include urinary bladder substitute , urethral grafts , achilles tendon replacement , dura graft , skin covering , and , now , most recently , abdominal wall repair . prevel in 1995 studied the use of sis mesh to repair a 2 x 2-cm hernia defect in sprague - dawley rats . this study found that no abdominal wall hernias had developed , and minimal intraabdominal adhesions were observed . clarke , the following year , reported a pilot study in dogs with sis mesh to repair full - thickness abdominal wall defects . small intestinal submucosa is found between the mucosal and muscular layers of the small intestine . the submucosa provides strength to the intestine and is predominantly a complex matrix of collagen . the submucosa is also a reservoir for cytokines that guide the repair and replacement of intestinal epithelial cells . sis works by providing a natural , extracellular matrix and acts as a scaffold for host cell incorporation and tissue remodeling . this preliminary report shows that porcine sis mesh can be used for laparoscopic inguinal hernia repairs .
introduction : using mesh or a synthetic prosthesis during the laparoscopic repair of inguinal hernias has been demonstrated to be safe and effective . 
 a new material , porcine small intestinal submucosa ( sis mesh ) , has been successfully used in canine and rodent animal models with excellent results . 
 this mesh is degradable and resorbable with a marked decrease in the possibility of becoming infected . 
 however , the amount of fibroblast ingrowth is equal to that with polypropylene mesh.methods:a comparison was made between this new sis mesh to repair 15 inguinal hernias in 12 patients and polypropylene mesh used in 12 similar patients . 
 a preperitoneal approach with balloon dissection was used in all patients.results:demographics were similar in both groups . 
 the results were excellent and compared equally . 
 complications ( seroma , discomfort ) were minimal in both groups and were similar.conclusions:porcine small intestinal submucosa , sis mesh , can be used for laparoscopic repair of inguinal hernias . 
 long - term follow - up will be necessary to confirm these preliminary results .