Abstract:
The present invention relates to devices and methods for the repair of hernia. One method for repairing a hernia the steps of making an incision through a skin layer of a patient near the hernia, creating an entrance into the preperitoneal space above the peritoneum at a location above the hernia, identifying and freeing a hernia sac, creating a pocket in the preperitoneal space, directing a surgical patch down through the incision and into the preperitoneal space, and expanding the surgical patch in the preperitoneal space. The method further includes the steps of inserting a distal end of a surgical fastening device through the incision and into the surgical patch, actuating the surgical fastening device to drive a fastener through the surgical patch and into the tissue of the patient, moving the distal end of the surgical fastening device to another location, actuating the surgical fastening device to drive a second fastener through the surgical patch and into the tissue of the patient, and closing the incision with stitches. One surgical apparatus for repairing a hernia includes a surgical stapling instrument for applying at least one surgical staple to fasten a surgical hernia patch to internal body tissue. The surgical instrument includes a handle assembly have a longitudinal axis. A staple cartridge housing is mounted to the handle assembly and is adapted to receive the at least one staple. The staple cartridge housing is dimensioned for insertion through an incision and has a staple actuator mechanism for applying the at least one staple into tissue. An actuation mechanism is operatively coupled to the staple actuator mechanism to operate the staple actuation mechanism.

Description:
TECHNICAL FIELD  
         [0001]    The present invention generally relates to the repair of internal body tissue. More particularly, the present invention relates to surgical instruments and procedures that can be used for the repair of hernias.  
         BACKGROUND OF THE INVENTION  
         [0002]    A hernia is a defect in a muscle of a person through which internal body organs can protrude into the inguinal tissue. This can happen in the groin area, the abdominal wall, the bowels, the diaphram, the scrotal sac or even a disk in the vertebral bones. Hernias can cause discomfort as well as a lump under the skin. The most common type of hernia occurs in the abdomen, in which part of the intestines protrude through the abdominal wall to form a hernial sac. When such a hernia occurs in the abdominal region, conventional corrective surgery has been required to correct the defect.  
           [0003]    Surgical mesh materials or patches have been developed for the repair of hernias. These mesh materials help reinforce and close the hernia. Various surgical techniques have been utilized to apply and secure the surgical mesh over the hernia. In one surgical approach, laparascopy techniques and devices are utilized to apply a surgical mesh from a remote location under the hernia to be repaired. This surgical operation generally involves repairing the hernia by retracting the intra-abdominal contents away from the hernia defect and then inserting a bundle of surgical mesh into the patient to block the defect. A surgical patch is usually secured over the mesh to hold it in place.  
           [0004]    However, surgical operations utilizing such laparacopic devices and techniques can be complicated. In addition, such operations typically require the use of general anesthesia and costly disposable instrumentation to support the laparoscopic surgery. In addition, this surgical technique can suffer from the difficulty of spreading and holding the surgical mesh over the defect in a satisfactory manner. Further, it may be difficult to affix the surgical patch in a smoothly expanded manner without causing substantial subsequent tension on the abdominal portions to which the mesh is affixed.  
           [0005]    In another surgical approach, a hernia can be repaired by attaching a surgical patch directly over the hernia. In this technique, a surgeon opens the abdominal cavity of a patient by a surgical incision through the major abdominal muscles. Several layers of the abdominal wall are generally separated to reach the herniated portions and to prepare an opening for the insertion of the surgical patch. Before the surgical patch is inserted into the patient, 4-12 sutures are passed under a memory recoil ring located near the perimeter of the patch. The surgeon then folds and compacts the surgical patch and inserts the patch through the incision into the patient&#39;s preperitoneal space. Thereafter, the surgeon uses his fingers to move and flatten out the patch within the preperitoneal space to ensure that none of the edges of the patch are flipped back. Once the hernia mesh patch covers the defect in the patient&#39;s abdominal cavity, the edges of the fascial defect are lifted and the perimeter sutures previously placed through the patch are passed through the peritoneum and posterior fascia/sheath. The sutures are then tied and trimmed.  
           [0006]    However, if the sutures are not passed through the tissue directly above the ring of the patch, the sutures may be placed under tension and the patch may become distorted. In addition, it can also be time consuming for the surgeon to secure all of the sutures in place. Further, the surgical patch utilized in this technique typically includes the use of a resilient circumferential ring located near the outer edge that creates tension throughout the patch to help expand the patch, thereby increasing the cost of the patch.  
         SUMMARY OF THE INVENTION  
         [0007]    In view of the above, the present invention provides surgical apparatus and procedures for the repair of hernia. The surgical apparatus and procedures provide a low cost and efficient procedure for the repair hernias. The surgical apparatus and procedures also allow a hernia to be repaired with less tension, a smaller wound or incision, superior fixation and at a potentially lower cost to the patient than traditional methods. The apparatus and procedures further allow a surgeon to secure a patch over a defect without the use of sutures and in less time than traditional surgical procedures.  
           [0008]    One method for repairing a hernia in accordance with the present invention includes the steps of making an incision through a skin layer of a patient near the hernia, creating an entrance into the preperitoneal space above the peritoneum at a location above the hernia, identifying and freeing a hernia sac, creating a pocket in the preperitoneal space, directing a surgical patch down through the incision and into the preperitoneal space, and expanding the surgical patch in the preperitoneal space. The method further includes the steps of inserting a distal end of a surgical fastening device through the incision and into the surgical patch, actuating the surgical fastening device to drive a fastener through the surgical patch and into the tissue of the patient, moving the distal end of the surgical fastening device to another location, actuating the surgical fastening device to drive a second fastener through the surgical patch and into the tissue of the patient, and closing the incision with stitches.  
           [0009]    One surgical apparatus in accordance with the present invention includes a surgical patch applicator for positioning a patch of surgical patch over a hernia defect. The surgical patch applicator generally includes an elongated member having a first end and a second end. The second end is sized for insertion into an opening of the surgical hernia patch. A lumen extends through the elongated member and a balloon is coupled to the second end of the elongated member. The balloon inflates in a planar direction to expand the surgical hernia patch over the hernia defect when a fluid is introduced into the lumen.  
           [0010]    Another surgical apparatus in accordance with the present invention includes a surgical stapling instrument for applying at least one surgical staple to fasten a surgical hernia patch to internal body tissue. The surgical instrument includes a handle assembly have a longitudinal axis. A staple cartridge housing is mounted to the handle assembly and is adapted to receive the at least one staple. The staple cartridge housing is dimensioned for insertion through an incision and has a staple actuator mechanism for applying the at least one staple into the tissue. An actuation mechanism is operatively coupled to the staple actuator mechanism to operate the staple actuation mechanism. A surgeon can rotate the staple cartridge housing in order to apply staples at desired surgical locations.  
           [0011]    The invention, together with further attendant advantages, will best be understood by reference to the following detailed description of the presently preferred embodiments of the invention, taken in conjunction with the accompanying drawings. It is to be understood that both the foregoing general description and the following detailed description are exemplary and explanatory and are intended to provide further explanation of the invention as claimed.  
       
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0012]    A preferred embodiment of the present invention will be described in detail below in connection with the drawings in which:  
         [0013]    [0013]FIG. 1 is a diagrammatical view of the repair of a hernia of a patient using surgical apparatus in accordance with the present invention;  
         [0014]    [0014]FIG. 2 is a fragmentary diagrammatical cross-sectional view of an incision in an abdominal wall of a patient having a hernia, wherein a surgical hernia patch is being prepared for insertion into the incision of the patient;  
         [0015]    [0015]FIG. 3 is a fragmentary diagrammatical cross-sectional view of the incision in the abdominal wall of FIG. 2, wherein the surgical hernia patch is being inserted into hernia of the patient;  
         [0016]    [0016]FIG. 4 is a fragmentary diagrammatical cross-sectional view of the incision in the abdominal wall of FIG. 2, wherein a balloon of a surgical patch applicator is inserted into the incision and into the surgical hernia patch;  
         [0017]    [0017]FIG. 5 is a fragmentary diagrammatical cross-sectional view of the incision in the abdominal wall of FIG. 2, wherein the balloon of the surgical patch applicator is inflated to expand the surgical hernia patch;  
         [0018]    [0018]FIG. 6 is a fragmentary diagrammatical cross-sectional view of the incision in the abdominal wall of FIG. 2, wherein a stapling cartridge housing of a surgical stapling instrument is inserted into the incision and into the surgical hernia patch;  
         [0019]    [0019]FIG. 7 is a side elevational view of the surgical patch applicator of FIG. 4;  
         [0020]    [0020]FIG. 8 is a side elevational view of the surgical stapling instrument of FIG. 6;  
         [0021]    [0021]FIG. 9 is a side elevational view of another embodiment of a surgical stapling instrument in accordance with the present invention;  
         [0022]    [0022]FIG. 10 is a side elevational view another embodiment of a surgical stapling instrument in accordance with the present invention, with the instrument in its extended position;  
         [0023]    [0023]FIG. 11 is a side elevational view of the surgical stapling instrument of  
         [0024]    [0024]FIG. 10, with the instrument in its retracted position;  
         [0025]    [0025]FIG. 12 is a side elevational view of another embodiment of the surgical stapling instrument having a plurality of staple cartridge housings in accordance with the preset invention;  
         [0026]    [0026]FIG. 13 is a perspective view of the surgical patch of FIG. 1; and  
         [0027]    FIGS.  14 - 20  show various embodiments of surgical fasteners. 
     
    
     DESCRIPTION OF PREFERRED EMBODIMENTS  
       [0028]    Before explaining the preferred embodiments in detail, it should be noted that the invention is not limited in its application or use to the details of construction and arrangement of parts illustrated in the accompanying drawings and description, because the illustrative embodiments of the invention may be implemented or incorporated in other embodiments, variations and modifications, and may be practiced or carried out in various ways. Furthermore, unless otherwise indicated, the terms and expressions employed herein have been chosen for the purpose of describing the preferred embodiments of the present invention for the convenience of the reader and are not for the purpose of limitation.  
         [0029]    Referring now to the drawings in detail, and particularly to FIGS.  1 - 6 , a procedure for the repair a hernia of a patient is illustrated. The surgical procedure allows a hernia to be repaired with less tension, a smaller wound or incision, superior fixation and at a potentially lower cost to the patient than traditional methods. The surgical procedure also allows a surgeon to repair a hernia more quickly than traditional techniques and without the use of sutures. Although the surgical procedure will be described in reference to a repair of an inguinal hernia, it will be recognized that the following surgical procedure can be used to repair other types of hernias and internal tissue of a patient.  
         [0030]    As shown in FIGS.  1 - 2 , the surgeon creates an entrance into the patient by opening the abdominal cavity by creating a surgical incision  100  through the major abdominal muscles. The surgical incision  100  is preferably positioned approximately two to three centimeters above the location where an inguinal hernia  102  has occurred. The surgical incision  100  can be made by a blade, such as a surgical scalpel.  
         [0031]    After the incision  100  is made in the abdominal cavity, the surgeon then works through the incision  100  and uses a muscle splitting technique to dissect deeply into the patient&#39;s preperitoneal space  104 . Several layers of the abdominal wall are generally separated to reach the herniated portions and to prepare an opening for the insertion of a surgical hernia patch  200 . During the separation, the surgeon identifies and frees up the hernia sac and creates a pocket  106  in the preperitoneal space  104  where the surgical hernia patch  200  can be inserted.  
         [0032]    After the pocket  106  in the preperitoneal space  104  has been created, the surgeon selects a suitable surgical hernia patch  200  to be used for the repair of the patient&#39;s hernia  102 . The selected surgical hernia patch  200  is folded and further compacted, as may be necessary, by the surgeon so that the selected surgical hernia patch  200  may be conveniently inserted through the incision  100  and down into the properitoneal space  104  as shown in FIG. 3.  
         [0033]    Once the surgical hernia patch  200  is inserted in the preperitoneal space  104 , the surgeon can then use a hernia patch applicator  300  to conveniently and accurately position the surgical hernia patch  200  to cover the hernia  102 . In order to position the patch, the surgeon inserts the hernia patch applicator  300  into the incision and into the surgical hernia patch  200  as shown in FIG. 4. A balloon  302  of the hernia patch applicator  300  is passed through a slit or hole  202  in the top layer of the surgical hernia patch  200  and into a pouch formed between the top and bottom layers of the surgical hernia patch  200 . The balloon  302  is then inflated to cause the surgical hernia patch  300  to unfold and expand into a planar configuration in the pocket  106  within the preperitoneal space  104  as shown in FIG. 5, thereby causing the surgical hernia patch  200  to expand over the hernia. The hernia patch applicator  300  can easily move and expand the surgical hernia patch  200  over the hernia  102  so that the edges of the surgical hernia patch  200  overlap the circumference of the hernia  102 . Once the surgical hernia patch  200  is properly positioned, the balloon  302  of the hernia patch applicator  300  is deflated and removed.  
         [0034]    Alternatively, the surgical hernia patch  200  may initially be placed over the balloon  302  of the surgical patch applicator  300  and then inserted into the incision  100  of the patient. Thereafter, the balloon  302  may be inflated to cause the surgical hernia patch  200  to expand over the hernia  102 . It will also be recognized that the surgeon may desire to use his fingers to position the surgical hernia patch  200  instead of using the hernia patch applicator  300 .  
         [0035]    Once the surgical hernia patch  200  is properly positioned, the surgeon closes the hernia  102  by applying a plurality of staples or fasteners with a surgical stapling instrument  400  to secure the surgical hernia patch  200  to the abdominal wall of the patient. In order to fasten the surgical hernia patch  200  to the abdominal wall, the surgeon inserts a staple cartridge housing  402  of the surgical stapling instrument  400  into the slit or opening  202  in the top layer of the surgical hernia patch  200  as shown in FIG. 6. When the staple cartridge housing  402  is positioned at a desired location, a staple actuator button  412  of the surgical stapling instrument  400  is pressed to drive a staple or fastener through the top layer of the surgical hernia patch  200  and into the tissue of the abdominal wall. Thereafter, the staple cartridge housing  402  is rotated to another location and the operation is repeated to drive another staple through the surgical hernia patch  200  and into the tissue. The staple cartridge housing  402  can be readily rotated to different positions to apply staples at various locations along the edges of the surgical hernia patch  200 . After the surgical hernia patch  200  is secured to the patient, the surgeon removes the surgical stapling instrument  400  and closes the incision  100 .  
         [0036]    Soon after the surgery, the patient&#39;s body reacts to the surgical hernia patch  200  and scar tissue grows into the patch to permanently fix the surgical hernia patch  200  in its intended position over the repaired area, where the hernia  102  was located. The surgical hernia patch  200  also helps protect against future hernias.  
         [0037]    Referring now to FIG. 7, a preferred embodiment of the surgical patch applicator  300  for use in the repair of a hernia is illustrated. The surgical patch applicator  300  allows a surgical hernia patch to be readily positioned over the circumference of the hernia. The surgical patch applicator  300  preferably includes an elongated body or tube  302  and an inflatable/deflatable balloon  304 .  
         [0038]    The elongated body  302  of the surgical patch applicator  300  preferably has a substantially circular cross-section, but may have any suitable cross-section, such as a square or an elliptical cross-section. The elongated body  302  can have any suitable length depending upon the particular hernia procedure and can be constructed of any suitable material that provides sufficiently rigidity to permit insertion of the elongated body into the herniated site. The elongated body  302  can be constructed from nylon, Teflon, polyurethane, or polyethylene. It will be recognized that the elongated body  302  can be made from a variety of other materials including, for example, polypropylene, polyamide, polyethylenterephthalate, polyamide, other polymers and polycarbonates as well as other suitable forms of plastic.  
         [0039]    The proximal end  306  of the elongated body  302  is attached to a connector or adaptor  308  through which fluid may be introduced under pressure into the balloon. The connector  308  permits the elongated body  302  to be attached or coupled to other devices, such as, a fluid source. The connector  308  can include, but is limited to, a Luer Lock connector, a quick connector, a ferrule connector, a threadable connector, and the like.  
         [0040]    As shown in FIG. 7, the elongated body  302  of the surgical patch applicator  300  further has an interior lumen or conduit  310  positioned therein. The lumen  310  can be any suitable size and shape. The lumen  310  extends longitudinally from the proximal end  306  of the elongated body  302  to an opening or aperture  312  at the distal end  314  of the elongated body  302 . The opening  312  permits the fluid to be transmitted through the lumen  310  into the interior of the balloon  304  to controllably inflate and/or deflate the balloon  304  as further described below.  
         [0041]    The balloon  304  of the surgical patch applicator  300  is preferably attached at the distal end  314  of the elongated body  302 . The balloon  304  can be made of latex, silicone rubber, polyethylene, polyamide or any other suitable material. The balloon  304  can be configured in various sizes. The balloon  304  is disposed over the opening  312  in the elongated body  302  to permit the lumen  310  to be in fluid communication with the interior of the balloon  304 . As a result, when fluid is transmitted through the lumen  310  and into the interior of the balloon  304 , the fluid will cause the balloon  304  to inflate. When the balloon  304  is inflated, the balloon  304  preferably expands radially outward or in a planar fashion to form a disk-like shape. FIG. 5 shows the balloon  304  in an expanded configuration in which the balloon  304  is inflated.  
         [0042]    When the fluid is extracted or removed from the interior of the balloon  304 , the balloon  304  will deflate. The fluid that may be used to inflate and deflate the balloon  304  can be a liquid, such as water or saline, or a gas, such as air, inert gas, carbon dioxide, helium, nitrogen, or the like. The fluid may be injected into and removed from the lumen  310  of the surgical patch applicator  300  by a fluid source such as, for example, a rubber bulb, a syringe, a micro pump or the like (not shown).  
         [0043]    Referring now to FIG. 8, a preferred embodiment of the surgical stapling instrument  400  for attaching a surgical hernia patch to internal body tissue is illustrated. The surgical stapling instrument  400  is adapted for insertion through a slit or a slot of the surgical hernia patch in order to apply one or more surgical staples through the top layer of the surgical hernia patch and into the patient&#39;s tissue at a desired surgical site. Preferably, the surgical stapling instrument  400  applies the staples near the edges of the surgical hernia patch. The surgical stapling instrument  400  may be readily rotated to various different positions to apply the staples or fasteners at various locations along the edges of the surgical hernia patch.  
         [0044]    As shown in FIG. 8, the surgical stapling instrument generally  400  includes a handle assembly  402  and a staple cartridge housing  404 . The handle assembly  402  preferably consists of a plastic material, but may be constructed from any suitable material. The handle assembly  402  of the surgical stapling instrument  400  generally includes an outer sleeve  406 , an inner sleeve or shaft  408 , a rotatable control knob  410 , and a stapler actuator button  412 .  
         [0045]    The outer sleeve  406  of the handle assembly  402  is substantially cylindrically shaped and is adapted to be held by a user or surgeon, but may be any suitable shape or size which allows it to be grasped by the user. The outer sleeve  406  may include a manual grip to facilitate grasping of the surgical stapling instrument  400  by a user.  
         [0046]    As shown in FIG. 8, the distal end  414  of the inner sleeve  408  is connected to the staple cartridge housing  404 , and the proximal end  416  of the inner sleeve  408  is coupled to the staple actuating button  412 . The staple actuating button  412  causes the surgical stapling instrument  400  to advance and drive a staple or fastener disposed in the staple cartridge housing  404  into the tissue at the surgical site.  
         [0047]    The rotatable control knob  410  of the surgical stapling instrument  400  is attached to inner sleeve  408  and is adapted to rotate the inner sleeve  408  about its longitudinal axis, thereby rotating the staple cartridge housing  404  relative to the outer sleeve  406  of the handle assembly  402 . The control knob  410  can rotate the staple cartridge housing  404  a full 360 degrees. The control knob  410  preferably comprises a disc-like member, but may be any suitable shape or size which allows it to be rotated by the user.  
         [0048]    The handle assembly  402  may also include a ratchet mechanism (not shown) to allow the user to set and retain the staple cartridge housing  404  at different rotational positions relative to the longitudinal axis of the outer sleeve  406  of the handle assembly  402 . The ratchet mechanism may be formed by a plurality of ratchet teeth on the outer wall of the inner sleeve  408  of the handle assembly  402  for engaging a pair of notches or detents mounted on inner wall of the outer sleeve  406 . The ratchet teeth and detents provide a ratchet mechanism for controlling and retaining the staple cartridge housing  404  in different rotational positions relative the longitudinal axis of the inner sleeve  408 . The notches can provide a series of stop positions which correspond to angular orientations preferably of 0, 45, 90, 135, 180, 225, 270, 315, and 360 degrees relative to the longitudinal axis of the inner sleeve  408 . In one embodiment, the inner wall of the outer sleeve is provided with notches which allow the staple cartridge housing  404  to be rotated in 8 equal angular increments of 45 degrees. It will be recognized that the outer wall of the inner sleeve may contain the notches while the inner wall of the outer sleeve contains the ratchet teeth.  
         [0049]    Referring still to FIG. 8, the staple cartridge housing  404  is mounted for rotation about the longitudinal axis of the handle assembly  402 . The control knob  410  of the surgical stapling instrument  400  can be turned by a user to rotate the staple cartridge housing  404  in order to adjust the rotational position of the staple cartridge housing  404  relative to the handle assembly  402 . The staple cartridge housing  404  includes a staple actuating device  418  and a staple or fastener cartridge  422 . The staple cartridge  422  of the surgical cartridge housing  404  contains a plurality of staplers or fasteners that can be driven upwardly relative to the longitudinal axis of the handle assembly  402  for placement in tissue. The staple actuating device  418  advances the staple and drives the staple into the tissue. The staple actuating device  418  preferably prevents more than one fastener from being placed in the “ready” position. A variety of actuation and fastener feeding mechanisms may be employed to advance the staplers or fasteners in the staple cartridge  422  of the surgical stapling instrument  400  and to place the fasteners in the tissue at the surgical site.  
         [0050]    In use, the stapling cartridge housing  404  is positioned at the desired position over the surgical site by operating the rotatable control knob  410  to adjust the rotational orientation of the staple cartridge housing  404 . With the staple cartridge housing  404  adjusted to the desired orientation, the staple actuator button  412  is squeezed to actuate the staple actuating device  418  to apply one of the staples to the tissue at the surgical site. Thereafter, the staple cartridge housing  404  is rotated to another location and the operation is repeated to apply another staple to the tissue. These features of the surgical stapling instrument  400  allow the staple cartridge housing  404  to be aligned with the desired region of the internal body tissue to which the staple or fastener is applied. Although the surgical stapling instrument  400  is described as a single load device, it will be recognized that it may be multiple load device. It will also be recognized that the surgical stapling instrument  400  may use any suitable staple or fastener, such as a surgical anchor, a surgical screw, or the like.  
         [0051]    Referring now to FIG. 9, another embodiment of a surgical stapling instrument  500  is illustrated. The surgical stapling instrument  500  in many respects corresponds in construction and function to the previously described surgical stapling instrument  400  of FIG. 8. Components of the surgical stapling instrument  500  which generally correspond to those components to the surgical stapling instrument  400  of FIG. 8 are designated by like reference numerals in the  500  hundred series. As shown in FIG. 9, the surgical stapling instrument  500  generally includes a handle assembly  502 , a staple cartridge housing  504 , and a staple actuating button  512 . In this embodiment, the surgeon manually rotates the handle assembly to rotate the staple cartridge housing  504 . It will also be recognized that a gripping member or outer sleeve may be coupled to the handle assembly  502 .  
         [0052]    Referring now to FIGS.  10 - 11 , another embodiment of a surgical stapling instrument  600  is illustrated. The surgical stapling instrument  600  in many respects corresponds in construction and function to the previously described surgical stapling instrument  500  of FIG. 9. Components of the surgical stapling instrument  600  which generally correspond to those components to the surgical stapling instrument  500  of FIG. 9 are designated by like reference numerals in the  600  hundred series. As shown in FIGS.  10 - 11 , the staple cartridge housing  604  of the surgical stapling instrument  600  can be extended and retracted to facilitate the insertion into a surgical hernia patch and/or application of fasteners. FIG. 11 shows the surgical stapling instrument  600  in its retracted position while FIG. 10 shows the surgical stapling instrument in its extended position. It will be recognized that the surgical stapling instrument  600  may include an outer sleeve (not shown) to facilitate rotation of the staple cartridge housing as described in reference to FIG. 8.  
         [0053]    Referring now to FIG. 12, another embodiment of a surgical stapling instrument  700  is illustrated. The surgical stapling instrument  700  in many respects corresponds in construction and function to the previously described surgical stapling instrument  500  of FIG. 9. Components of the surgical stapling instrument  700  which generally correspond to those components to the surgical stapling instrument  500  of FIG. 9 are designated by like reference numerals in the  700  hundred series. As shown in FIG. 12, the surgical stapling instrument  700  includes a second staple cartridge housing  705 . It is contemplated that the surgical stapling instrument can have any suitable number of staple cartridge housings. The surgical stapling instrument  600  may include an outer sleeve (not shown) to facilitate rotation of the staple cartridge housing as described in reference to FIG. 8. It will be recognized that the stapling cartridge housings  704  and  705  of surgical stapling instrument  700  may be retracted and expanded as described in reference to FIGS. 10 and 11.  
         [0054]    Referring now to FIG. 13, one embodiment of a surgical hernia patch  800  for implanting within a patient&#39;s body space for the repair a hernia is shown. The surgical hernia patch is composed of a top layer  802  and a bottom layer  804 . The top and bottom layer are preferably constructed of a polypropylene material. The top and bottom layer are secured together near their outer edges to hereby form a pocket therebetween. The top layer preferably has a circular opening  806  adapted to receive a balloon of a surgical patch applicator and a staple cartridge housing of a surgical stapling instrument. Preferably, the patch does not contain memory recoil ring that is typically located near the perimeter of the patch.  
         [0055]    FIGS.  14 - 19  illustrate a variety of fasteners that can be used to attach a surgical hernia patch to the tissue of the patient. The fasteners can be constructed from any suitable material. FIG. 20 shows another embodiment of a fastener  900  that can be used to attach a surgical hernia patch to the tissue of the patient. The fastener  900  can be filled with an adhesive substance, such as bio-glue, to facilitate the attachment of the fastener to the tissue. When the fastener  900  is applied to the tissue, the adhesive substance is forced out of the fastener  900  through at least one aperture or hole  902  and into the surrounding tissue.  
         [0056]    The surgical apparatus and procedures described above allow a hernia to be repaired with less tension, a smaller wound or incision, superior fixation and at a potentially lower cost to the patient than traditional methods. The surgical procedures also allow a surgeon to repair a hernia more quickly than traditional techniques and without the use of sutures.  
         [0057]    Although the present invention has been described in detail by way of illustration and example, it should be understood that a wide range of changes and modifications can be made to the preferred embodiments described above without departing in any way from the scope and spirit of the invention. For example, a fiber optic visualization apparatus can be incorporated into any of the surgical apparatus described above. Thus, the described embodiments are to be considered in all respects only as illustrative and not restrictive, and the scope of the invention is, therefore, indicated by the appended claims rather than the foregoing description. All changes that come within the meaning and range of equivalency of the claims are to be embraced within their scope.