CHOICE OF INGUINAL HERNIA REPAIR PROCEDURE

Abstract

Although many surgeons now prefer the Lichtenstein operation, the optimal technique for inguinal hernia repair remains controversial. Although many studies have compared Lichtenstein, TAPP and TEP operations, there is no single solution. Therefore, in our work, we considered and analyzed the effectiveness of the treatment of inguinal hernias with these three currently recommended methods.
 Aim. To compare TAPP, TEP, and Lichtenstein based on analysis of immediate treatment outcomes.
 Materials and methods. We performed surgical treatment of inguinal hernia in 211 patients. All of them underwent tension-free hernia repair using a prolene prosthesis. Lichtenstein procedure was performed in 65 patients (Lichtenstein group), TAPP (TAPP group) in 81 patients and TEP (TEP group) in 65 patients.
 Results. The time of operation in patients of different groups differed improbably, although this indicator was the highest in the TEP group. Length of hospital stay was lowest in the Lichtenstein group and highest in the TEP group, although no statistical significance was observed. The terms of outpatient treatment were improbably the lowest in the TAPP group and the highest in the TEP group. The lack of statistical probability between these analyzed indicators allowed us to state that all procedure for inguinal hernia did not differ in terms of operation time and terms of postoperative medical, social and physical rehabilitation. The frequency of inguinal hematoma, subcutaneous emphysema, and seroma was probably (p<0.05) highest in the TEP group. Shoulder scapular pain syndrome occurred more often in the TAPP group (p<0.001). The frequency of development of other complications between patients of all three groups differed improbably. When TAPP was performed, in comparison with only TEP, shoulder scapular pain syndrome probably developed more often (OR 10.06, 95 %, CI 1.26–80.10, p = 0.019; χ2 = 5.43), however, the frequency of subcutaneous emphysema (OR 0.57, 95 %, CI 0.24–1.36, p=0.29; χ2=1.10) and hernia recurrence (OR 1.62, 95%, CI 0.14–18.28, p = 0.84; χ2 = 0.04) differed improbably.
 Conclusions. We did not notice significant differences in the duration of the operation, the frequency of postoperative complications, the length of stay in the hospital, and the recovery of work capacity and quality of life when using the currently recommended methods of inguinal hernia repair. This makes it possible to choose a method of hernia treatment, focusing more on anesthetic contraindications and concomitant diseases.