The technical characteristics and immediate results of laparoscopy trans-peritoneal and total extra-peritoneal hernioplasty

Abstract

Over the time of recent years, in surgical treatment of inguinal hernia such revolutionary changes occurred as implementation of Lichtenstein's nonstrain prosthetic inguinal hernioplasty (1986) into surgical practice and application of laparoscopic hernioplasty (Arregui M.E., 1992; McKernan and Ferzli, 1993). The study was carried out to evaluate reliability and effectiveness of application of trans-peritoneal and total extra-peritoneal hernioplasty in case of inguinal hernia. During 2012-2015, in the municipal clinical hospital №4 and the Russian gerontological research clinical center (Moscow) 12 patients underwent 12 hernioplasties using technique of total extra-peritoneal hernioplasty and 65 patients underwent 73 hernioplasties using technique of trans-peritoneal hernioplasty (in 8 cases herniae were bilateral). The technical intra-operational characteristics of procedures were analyzed. The evaluation of intra-operational and post-operational complications during earlier post-operational period and in a year after operation was carried out. The single patient in the group of total extra-peritoneal hernioplasty inguinal hernia was relapsing after herniotomy with plasty with local tissues. All herniae were one-sided. The average duration of operation made up to 62.5 minutes. The conversion was never required. In the group of trans-peritoneal hernioplasty average duration of operation made up to 58.5 minutes. The conversion was never required too. The rate of intra-operational complications in both groups was low. The most of the patients in main group (total extra-peritoneal hernioplasty) were ready to be discharged from the hospital at second day after operation. The total rate of post-operative complications made up to 20.6%. Only in the group of trans-peritoneal hernioplasty single relapse was observed after three months after operation. According to results of study, the laparoscopic inguinal hernioplasty is the most preferable and rational treatment of most of the types of inguinal herniae. The total extra-peritoneal hernioplasty is more preferable than trans-peritoneal hernioplasty because of number of reasons i.e. the post-operative pain is less expressed; operation is performed in retroperitoneal way; the risk of damaging of internal organs and development of peritoneal commissures is minimized.