The results of preperitoneal inguinal hernioplasty without fixation of the mesh endoprosthesis in the experiment.

Abstract

The purpose of the study is experimental development of preperitoneal inguinal hernioplasty with synthetic mesh, according assessment of the need of its fixation to the tissues.
 Materials and methods. An inguinal hernia was simulated on human cadaveric material. The study used 27 male corpses. Two inguinal hernias were modeled on one corpse: on one side - indirect, on the other - direct. A polypropylene mesh (standard density, 15 x 15 cm) was placed in the preperitoneal space. The endoprosthesis was impacted from the side of the abdominal cavity by a special designed device. The effect of a peak intra-abdominal pressure of 200 mm Hg was simulated. The degree of displacement of the reticular endoprosthesis into the inguinal canal was estimated at the moment of peak pressure on it from inside the abdominal cavity. For a simulated indirect inguinal hernia, two variants of the technique were considered: with fixation of the endoprosthesis to the underlying tissues and without fixation. For the modulated direct inguinal hernia, the following options were considered: non-fixative, with fixation at one point to the pubis and with plasty of the transverse fascia.
 Results. When modeling preperitoneal plasty of a direct inguinal hernia, there is a pronounced displacement of the endoprosthesis into the inguinal canal with a non-fixing plasty, unlike the method with transverse fascia plasty or fixation to the pubis. In indirect inguinal hernia, there was no significant displacement of the endoprosthesis in both considered variants.
 Conclusions. According to the obtained results, conclusions were drawn on the need for additional plasty of the transverse fascia or fixation of the endoprosthesis at a single point in a direct inguinal hernia. With indirect inguinal hernia in the experiment, no significant difference in the displacement of the mesh endoprosthesis into the inguinal canal was obtained with and without fixation.