Endosurgical aspects of diagnosis and treatment of strangulated inguinal hernias (a brief literature review)

Abstract

Inguinal hernias are among the most common surgical diseases, 10–15 % of which are complicated by strangulation. Emergent surgery in such cases are associated with a high frequency of hernia recurrence (up to 30 %), and difficulties in diagnosing hernial strangulation lead to a long delay in operations and dramatically increase postoperative mortality up to 4–12 %. The review of the literature in the historical perspective reflects the use of videolaparoscopic techniques with diagnostic and therapeutic purposes for acute hernial incarceration. The experience of diagnostic videolaparoscopy for strangulated hernias of all kinds of localization accumulated in the world practice indicates a very high sensitivity of the method that allows recognizing hernial strangulation, differentiating it from other diseases, verifying organs that have undergone incarceration, and assessing their viability. However, targeted studies of the diagnostic capabilities of videolaparoscopy for strangulated hernias have not been conducted. By 2009, 7 articles had been published in the world press on the treatment of strangulated inguinal hernias by laparoscopic (TAPP) or endosurgical (TEP) methods. A meta-analysis of these publications showed that laparoscopic hernioplasty for strangulated hernias is a performable operation with acceptable results. Further studies have identified a number of physiological and socio-economic advantages of endosurgical operations compared to open methods of prosthetic hernioplasty. However, such operations remain the lot of a narrow circle of specialists. To date, there are no randomized trials or systematic reviews on hernioplasty techniques for TARR and TER in patients with strangulated inguinal hernias. The question about optimal method of eliminating a strangulated inguinal hernia is not covered in modern literature and is still pending.