THE CHOICE OF A TREATMENT METHOD OF RECURRENT INGUINAL HERNIA

Kravtsiv M. I., Dudchenko M. O.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific 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.

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«Bulletin of problems biology and medicine» Issue 2 (156), 2020 year, 112-116 pages, index UDK 616.34-007.43-089

10.29254/2077-4214-2020-2-156-112-116