THE CHOICE OF A TREATMENT METHOD OF RECURRENT INGUINAL HERNIA
About the author:
Kravtsiv M. I., Dudchenko M. O.
CLINICAL AND EXPERIMENTAL MEDICINE
Type of article:
Objectives. Analysis of the causes of development and methods of surgical treatment of recurrent inguinal hernias (RIGs). Based on their results, the establishment of a priority method for the treatment of RIGs. Methods. The article analyzes the experience of treating 131 patients with recurrent inguinal hernia who were undergoing elective surgery from 2005 to 2019 in the surgical departments of the Poltava Central District Clinical Hospital, the 2nd Poltava City Clinical Hospital and the 3rd Poltava City Clinical Hospital. Men accounted for about 95.4% of patients with RIGs. According to the nature of prior repair, patients were characterized as follows: in 110 (84%) patients relapses occurred after autoplastic methods (Girard-Spasokukotsky-Kimbarovsky 68 (52%) cases, Bassini – 25 (19%) and Postempsky 17 (13%) cases) and in 21 (16%) patients – after hernioplasty according to Lichtenstein. For the first time recurrent hernias were met in 115 (87,8%) patients, re-recurrence – in 11 (8,4%), multiple recurrence – in 5 (3,8%). Results. Among the revealed causes of relapses after Lichtenstein repair were surgical technique abnormalities and suppuration of the postoperative wound, whereas after the fasciomyoplastic methods of plastic of the inguinal canal, development of atrophic and degenerative changes in the inguinal area was observed. Patients with RIGs had the following types of repair: trans abdominal pre-peritoneal repair (TAPP) in 49 (37.4%) patients and Lichtenstein in 46 (35.1%) patients using a polyprophylene mesh implant; in 23 (17.5%) cases, Postempsky, in 7 (5.3%) patients – according to Bassini and 6 (4.6%) – according to Girard. The average bed day was 5.8 ± 1.6 days. The intraoperative and early postoperative complications were evaluated. Conclusion. In order to individualize the approach in the treatment of patients with RIGs, it is advisable to distinguish the types of RIGs. It has been established that the most effective and least traumatic method of a recurrent inguinal hernia repair that has arisen after anterior plastic of the inguinal canal is the laparoscopic TAPP method, without isolating the elements of the spermatic cord.
inguinal hernia, recurrence, repair, surgery.
- Sayenko VF, Belyanskiy LS, Lavrik AS. Sovremennyye podkhody k vyboru metoda plastiki retsidivnoy pakhovoy gryzhi. Gerniologiya. 2007;3:11-5. [in Russian].
- Acquaviva Don E, Bourret P, Corti F. Consideration sur 1’emploi de plaques de nylon comme materiel de plastic parietale. 52 Congres Francais de Chirurgie. Paris: 1949. р. 453-7.
- Amid JP. Classification of biomaterials and their related complications in abdominal wall hernia surgery. Hernia. 1997;1:15-21.
- Brenner J. Mesh materials in hernia repair. Expert meeting on hernia surgery. St. Moritz: Basel. Karger; 1995. р. 172-9.
- DeBord JR. The historical development of prosthetics in hernia surgery. Surg. Clin. N. Am. 1998;78:1089-102.
- Shulman AG, Amid PK, Lichtenstein IL. The «plug» repair of 1402 recurrent inguinal hernias; 20 year experience. Arch. Surg. 1990;125:265-7.
- Burcharth J, Pommergaard HC, Bisgaard T, Rosenberg J. Patient-related risk factors for recurrence after inguinal hernia repair: a systematic review and meta-analysis of observational studies. Surg Innov. 2015;22(3):303-17. DOI: 10.1177/1553350614552731
- Vărcuş F, Duţă C, Dobrescu A, Lazăr F, Papurica M, Tarta C. Laparoscopic Repair of Inguinal Hernia TEP versus TAPP. Chirurgia (Bucur). 2016;111(4):308-12.
- Ramjist JK, Dossa F, Stukel TA, Urbach DR, Fu L, Baxter NN. Reoperation for inguinal hernia recurrence in Ontario: a population-based study. Hernia. 2019;23(4):647-54. DOI: 10.1007/s10029-018-1822-0
- Lichlenstein IL, Shulman G. Ambulatory outpatient hernia surgery including a new concept introducing tension – free repair. Int. Surg. 1986;71:1-4.
- Ijzermans JNM, H de Wilt, Hope WC, Jeekel H. Recurrent inguinal hernia treated by classical hernioplasty. Arch. Surg. 1991;3(126):1097- 100.
- Katri KM. Open preperitoneal mesh repair of recurrent inguinal hernia. Hernia. 2009;13:585-9.
- Campanelli G, Pettinari D, Nicolosi FM, Cavalli M, Avesani EC. Inguinal hernia recurrence: classification and approach. Hernia. 2006;10(2):159-61.
- The Hernia Surge Group. International Guidelines for Groin Hernia Management. Hernia. 2018;22(1):1-165. DOI: 10.1007/s10029-017- 1668-x
Publication of the article:
«Bulletin of problems biology and medicine» Issue 2 (156), 2020 year, 112-116 pages, index UDK 616.34-007.43-089