Large Inguinal Hernia Research Articles

A Case of Optimizing Anesthetic Management for an Elderly Patient with Severe Left Ventricular Dysfunction Through a Multi-disciplinary Treatment Approach

This case report presents a multi-disciplinary treatment (MDT) approach to optimize anesthetic management for an elderly patient with a giant inguinal hernia and severe left ventricular dysfunction. The patient, a 68-year-old male, had a 30-year history of a large inguinal hernia and was diagnosed with left ventricular hypertrophy and cardiac insufficiency, with an ejection fraction of 24%. Given the patient's complex comorbidities and the risks associated with anesthesia, a MDT was formed to develop a personalized treatment plan. The team included gastrointestinal surgeons, anesthesiologists, cardiovascular specialists, and intensive care physicians who collaborated to mitigate perioperative risks. The MDT strategy involved continuing preoperative cardiovascular medications, selecting anesthesia techniques to minimize impact, and maintaining strict fluid management during surgery. The patient underwent a successful tension-free repair of the inguinal hernia with the aid of an ultrasound-guided nerve block and local infiltration anesthesia. Throughout the procedure, vital signs remained stable, and the patient experienced no discomfort or complications related to anesthesia. The patient recovered well and was discharged after five days. The effectiveness of MDT in overseeing the care of elderly patients with high-risk conditions throughout the perioperative anesthesia phase is underscored. It underscores the importance of a collaborative approach to ensure patient safety and optimal outcomes in complex surgical cases. The MDT framework helps to prevent treatment deviations and delays, reducing patient anxiety and improving the overall quality of care.

A Simple and Effective Technique for Torn Hernial Sac Occurred During Large Inguinal Hernia Repair or Orchiopexy: Incision

Tearing of hernial sac during giant inguinal hernia repair or orchiopexy presents a challenge to the pediatric surgeons, even in expert hands. We here describe a technique that is easy for performing high ligation in cases complicated with torn hernial sac. The steps of our incision technique is: Non-separated part was tightened with the help of forceps localized at the lateral aspects of teared sac. The incision to the sac was fashioned by scalpel No 15, while taking care to avoid injury to the underlying testicular vessels and vas deferens. Then, wound edges of the proximal hernia sac were moved forward by using fine tissue forceps and scalpel. The walls of proximal sac were totally grasped in one forceps and dissected gently from the remaining adhesions and cremasteric fibers up to the level of the internal ring. The mean age of the patients was 13.9±18.1 months (range 3 weeks-7 years). The diagnosis of the patients was inguinal hernia in 17 (63%) and undescended testis in 10 (37%). Seven (25,9%) of the patients had a large inguinal hernia sac. There were no intraoperative and postoperative complications. This is a safe and effective technique in patients complicated with torn hernial sac during herniotomy. It reduces the risk of further tearing of hernial sac. Short duration is another advantage. This technique can also be performed with using surgical loupe or microscope to care not to damage the vas and vessels.

Progressive preoperative pneumoperitoneum in a patient with giant inguinal hernia: report of a case

Giant hernias have chronic abdominal wall defects that slowly and progressively grow and alter the normal physiology of the abdominal wall. The clinical case we report is a 76-year-old male who began 7 years ago with protrusion in the left inguinal area with progressive increase in volume until reaching the inability to walk is presented. The protocol is followed by pneumoperitoneum insufflation with 500-1000 milliliters (ml) of carbon dioxide daily for 10 days. The treatment of large hernia defects of the abdominal wall produces a large increase in intra-abdominal pressure during visceral reduction, which entails an alteration in cardiorespiratory biomechanics by elevating the diaphragm and reducing venous return. This technique would be indicated in hernias greater than 10 centimeters (cm), as well as in large inguinal and umbilical hernias, with irreducible sacs, with "loss of domain". It is protocolized with preoperative preparation with pneumoperitoneum for 10 days, for subsequent inguinal plasty with Lichtenstein technique, during which a minimum of adhesions were found, managing to preserve the ipsilateral testicle, reducing surgical time and hospital stay, with no data on compartment syndrome in the abdomen after surgery, providing a good alternative in this type of condition.

P-036 SUTURING OF THE INTERNAL INGUINAL ORIFICE DURING THE LAPAROSCOPIC TRANSABDOMINAL REPAIR OF A LARGE INDIRECT INGUINAL HERNIA

Abstract Aim To present the rationale and surgical technique of the internal inguinal orifice suturing during transabdominal preperitoneal hernia repair of large inguinal hernias. Methods The surgical steps of a laparoscopic transabdominal preperitoneal hernia repair (TAPP) with the addition of the suturing reconstruction of the internal orifice are presented. Results A 52-year-old man presented with a large symptomatic right inguinal hernia. A TAPP repair was performed. Due to a significantly widened internal inguinal orifice, reconstruction of the deep ring was performed by suturing the transversalis fascia arc to the iliopubic tract with a self-locking 2-0 stitch in a continuous fashion. Accordingly, a medium-weighted polyester mesh was applied. The patient had an uneventful postoperative period, without symptoms of chronic pain or discomfort at a 6-month follow-up. Conclusions During the laparoscopic repair of large indirect inguinal hernias, suturing reconstruction of the internal orifice, similar to the common practice for open inguinal hernia repair, may reduce mesh eventration and recurrence.

Robotic Approach to Large Inguinal Hernia Containing Native Pelvic Kidney

Robotic Approach to Large Inguinal Hernia Containing Native Pelvic Kidney

P-080 LAPAROSCOPIC TRANSABDOMINAL RETROMUSCULAR UMBILICAL PROSTHETIC HERNIA REPAIR (LAP-TARUP) & TAPP-INGUINAL IN A SINGLE TIME: A GOOD OPTION IN OBESE PATIENTS?

Abstract Aim The association between midline hernias (primary-or-incisional) and inguinal-hernias is not uncommon, nor is its association with obesity, which increases its incidence every day. In obese patients, the laparoscopic-eTEP-approach to treat ventral hernias is a feasible option but with greater surgical difficulty and worse ergonomics. The laparoscopic-TARUP-approach(TransAbdominal-Retromuscular-Umbilical-Prosthetic-Hernia-Repair) offers the advantages of MIS with better ergonomics in obese patients or those with irreducible incarcerated hernias. Material and Method 77-year-old male patient with obesity (BMI:37.58kg/m2), previous laparoscopic gallbladder surgery,who presents umbilical eventration(EHS: M2–3W2(8cm)) associated with diastasis,in addition to incoercible left inguino-scrotal hernia. Results 5ports are used to perform the surgery.Initially,the classic TAPP-approach of the left inguinal-hernia is performed.After that the video-endoscope is changed to the location of the right flank and continues with the opening at the lateral edge of the posterior sheath of the right-rectum, the retromuscular-space is dissected and the supraumbilical cross-over and subsequent opening of the posterior contralateral sheath is performed.The dissection and reduction of the hernial sac is continued, and the dissection of the left retromuscular-space is completed.The anterior hernia defect is closed and diastasis is replicated with Stratafix-0.Closure of the posterior sheath of the rectums is performed with V-Lock 3–0. A 21×24cm PVDF-mesh is placed in a retromuscular position fixed with Fibrin, and the lateral opening is closed with V-Lock.The patient had a favourable postoperative period. Conclusions The TARUP-approach in midline hernias in obese patients is a valid,safe and better ergonomic option, and is also useful for simultaneously resolving large inguinal hernias by TAPP-approach,as in the case presented.

BJS-03 DO WE NEED FIXATION OF THE MESH IN LAPAROENDOSCOPIC TECHNIQUES FOR M3 INGUINAL DEFECTS? AN EXPERIMENTAL STUDY

Abstract Background Hernia societies strongly recommend fixing the mesh in case of large M3 defects in laparoendoscopic repairs. The purpose is to reduce recurrence, which is alarmingly high for this defect. The authors conducted a research experiment to verify the hypothesis that it is possible to preserve the mesh in the operating field in large direct hernias (M3) without the need to use fixing materials. Method Authors conducted an experiment with scientists from Universities of Technology in a model that reflects the conditions in the groin area. By simulating conditions of the highest possible intra-abdominal pressure, they examined the mesh behavior within the groin and its ability to dislocate under the forces generated by this pressure. The experiment involved six spatial implants and one flat macroporous mesh. Results Heavyweight spatial meshes and lightweight spatial individualized mesh showed no tendency to dislocate or move directly to the gate, which was considered a rapid hernia recurrence. Lightweight Meshes, both spatial and flat, underwent significant migration and shifting towards the hernial gates. Conclusion Based on the results, we believe that mesh fixation is not the only alternative to preventing recurrence in complex defects. Similar effects can be achieved by using a larger, more rigid and anatomically fitted implant. The type of implant (rather than its fixation) seems to be a key factor from the point of view of mechanics and biophysics. Clinical trials confirming the results in vivo, will allow to supplement or amend the guidelines for the treatment of large inguinal hernias.

Is mesh fixation necessary in laparoendoscopic techniques for M3 inguinal defects? An experimental study.

Although international guidelines recommend not fixing the mesh in almost all cases of laparoendoscopic repairs, in case of large direct hernias (M3) mesh fixation is recommended to reduce recurrence risk. Despite lack of high-quality evidence, the recommendation was upgraded to strong by expert panel. The authors conducted a research experiment to verify the hypothesis that it is possible to preserve the mesh in the operating field in large direct hernias (M3) without the need to use fixing materials. The authors conducted an experiment with scientists from Universities of Technology in a model that reflects the conditions in the groin area. By simulating conditions of the highest possible intra-abdominal pressure, they examined the mesh behavior within the groin and its ability to dislocate under the forces generated by this pressure. The experiment involved six spatial implants and one flat macroporous mesh. Heavyweight spatial meshes and lightweight spatial-individualized meshes showed no tendency to dislocate or move directly to the orifice, which was considered a rapid hernia recurrence. Lightweight meshes, both spatial and flat, underwent significant migration and shifting toward the hernial orifices. Based on the results, we believe that mesh fixation is not the only alternative to preventing recurrence in complex defects. Similar effects can be achieved using a larger, more rigid, and anatomically fitted implant. The type of implant (rather than its fixation) seems to be a key factor from the point of view of mechanics and biophysics. Clinical trials confirming the results in vivo will allow to supplement or amend the guidelines for the treatment of large inguinal hernias.

A FEATURE OF LAPAROSCOPIC TREATMENT OF IRREDUCIBLE AND LARGE INGUINAL HERNIAS

Summary. Introduction. The inguinal hernia is one of the most common surgical problems around the world. Patients with large inguinal and inguinal hernias are a certain group. At present, there are no final convincing evidence of the advantage of laparoscopic hernia repair of complex forms of inguinal hernias, indications and contraindications to various methods of this operation, the technology of performing surgical interventions for various types of complex inguinal hernias has not been completed.
 Aim. Perform perioperative complications in surgical treatment of unrecognizable and large inguinal hernias with laparoscopic modified TAPP method, classic Laparoscopic TEP laparoscopic technique and inguinal canal plastic according to Lichtenstein.
 Materials and methods. Surgical treatment of 42 patients with unrecognizable and large inguinal hernias was performed. All of them were performed incapacitated plastic with the use of a prone grid. In 12 patients, the Lichtenstein (Lichtenstein group) was performed, 18 patients with a modified technique (TAPP group) and 12 — TEP (TEP group). Modification was a high resection of the hernia sac in patients with inguinal-callous hernia, and the techniques of digestion of the peritoneum with a fixed gut in cases where the intestine is tightly fictoned in a large length to the peritoneum in the area of the hernia sac.
 Results of the research. Application in the performance of transabdominal preperitoneal hernia repair of the technique of high resection of the hernia sac in patients with inguinal-potassium hernia, and methods Surgery, reduce the frequency of hematoma and inflammatory processes in the TAPP surgery area is likely (p < 0.05), and reduce the number of conversions in the TAPP group.
 Conclusions. Diagnostic laparoscopy is a necessary highly informative stage of diagnosis and determination of surgical tactics for complex types of inguinal hernias. Laparoscopic hernia repair of complex forms of inguinal hernias is a method of choice, which provides low trauma, asepticity, good conditions for wound healing. Modified technique of transabdominal preperitoneal hernia repair of complex inguinal hernias, which reduced the trauma of the operation and thus reduce intra and postoperative complications that are manifested by the formation of hematoma and inflammatory processes in the surgery.

Zig Maneuver in Total Extraperitoneal Inguinal Hernia Repair.

The difficulties in the hernia sac dissection in repairing large inguinal hernias with the endoscopic total extraperitoneal (TEP) technique prolong the operation and increase the risk of injury. This study investigates the effectiveness of the Zig maneuver (ligation of the hernia sac at the deep inguinal ring) in TEP in male patients with L3 inguinal hernia by European Hernia Society classification. A total of 224 male patients with L3 inguinal hernia who underwent laparoscopic TEP surgery in 2018 and 2019 were retrospectively screened and included in the study. The patients were divided into 2 groups as Zig group (n=99) and the non-Zig group (n=125), depending on whether the Zig maneuver was performed during TEP application. The mean patient age was 45.49 for the non-Zig group and 47.12 for the Zig group. The median operative time was 50 minutes in the non-Zig group and 43 minutes in the Zig group (P<0.005). The median value of the postoperative first 24 hours pain score was 3 in the non-Zig group and 2 in the Zig group (P=0.033). Scrotal edema was 7.2% in the non-Zig group and 1% in the Zig group (P=0.023). According to logistic regression analysis, the Zig maneuver reduced the probability of scrotal edema by 87% in almost the entire population (odds ratio=0.130, 95% confidence interval: 0.016-1.047). There was no statistically significant difference between the groups in terms of early and late recurrence. Zig maneuver shortened the operative time and significantly reduced the feeling of pain in the first 24 hours postoperatively in male patients with indirect L3 hernia who underwent endoscopic TEP. It also significantly reduced the likelihood of scrotal edema in almost the entire population. As a result, the Zig maneuver is an effective method that could be applied during endoscopic TEP.

Endoscopic findings of a large inguinal hernia: the in-and-out sign

Endoscopic findings of a large inguinal hernia: the in-and-out sign

Analysis on Influencing Factors of Recurrence after Indirect Inguinal Hernia Laparoscopic Surgery.

This paper aims to analyze the recurrence of indirect inguinal hernia in children after laparoscopic surgery and investigate the influencing factors that may lead to recurrence so as to guide the prevention and treatment of postoperative recurrence of this kind of disease in the future. The data of 260 children with indirect inguinal hernia treated by laparoscopic surgery and followed up in our hospital from July 2019 to July 2021 were selected. A self-designed questionnaire was used to collect the basic data. The recurrence was analyzed, and the influencing factors of recurrence were analyzed by univariate analysis and multivariate analysis. Among 400 children after indirect inguinal hernia laparoscopic surgery, an occurrence was observed in 15 children, and the recurrence rate was 5.77%. Univariate analysis showed that the age and course of disease were not correlated with recurrence after indirect inguinal hernia laparoscopic surgery (P > 0.05). Being male, bilateral lesions, exact high ligation, loose hernia back wall peritoneum, deciduous ligature, incorrect ligation of the fascia of musculus obliquus externus abdominis, large inguinal hernia, circumferential wiring, and too early off-bed activity were the influencing factors of recurrence after indirect inguinal hernia laparoscopic surgery (P < 0.05). Logistic multivariate regression analysis showed that being male, bilateral lesions, loose hernia back wall peritoneum, deciduous ligature, incorrect ligation of the fascia of musculus obliquus externus abdominis, large inguinal hernia, and too early off-bed activity were the influencing factors of recurrence after indirect inguinal hernia laparoscopic surgery (OR>1, P < 0.05). Exact high ligation and circumferential wiring were protective factors of recurrence after indirect inguinal hernia laparoscopic surgery (OR>1, P < 0.05). After indirect inguinal hernia laparoscopic surgery, recurrences were affected by many factors, such as gender, site of pathological changes, and loose hernia back wall peritoneum. For these children with risk factors, reasonable intervention should be taken to reduce recurrence; exact high ligation and circumferential wiring are the protective factors. If permitted, the children meeting related indications can be treated by high ligation or circumferential wiring to reduce the risk of recurrence after indirect inguinal hernia laparoscopic surgery.

\u201cLocus minoris resistentiae\u201d and connective tissue weakness in older women: a case report and literature review on pelvic organ prolapse with inguinal bladder hernia

BackgroundConditions such as genital prolapse and hernia are known to be related to connective tissue dysfunction. In this report on cases of the rare simultaneous finding of large genital prolapse and post-prolapse repair female inguinal bladder hernia, we aim to contribute to the discussion of a possible clinical definition of connective tissue weakness, for its clinical assessment and preoperative patient counselling.Case presentationThree cases of medial third-grade (MIII, Aachen classification) inguinal bladder hernia developing or enlarging after successful stage-IV pelvic organ prolapse (POP) repair at a university pelvic floor centre are presented. All patients were aged ≥ 80 years with long-standing postmenopausal status. One patient was followed for 5 years and two patients were followed for 6 months. In all patients, ultrasound revealed that the hernia sac contained the urinary bladder, which had herniated through the inguinal hernia orifice. A literature search revealed only one case report of direct female inguinal bladder hernia and few investigations of the simultaneous occurrence of POP and hernia in general.ConclusionThe simultaneous occurrence of inguinal hernia and female POP can lead to bladder herniation following prolapse surgery in the sense of a “locus minoris resistentiae”. Clinical examination for simultaneous signs of connective tissue weakness and counselling prior to pelvic reconstructive surgery could help to increase patients’ compliance with further surgical treatment for hernia.

P123 TAPP - THE BEST APPROACH FOR INGUINAL HERNIA ASSOCIATED WITH ADULT CRYPTORCHIDISM: CASE REPORT AND LITERATURE REVIEW

Abstract Aim Cryptorchidism is a rare condition of adult male. The diagnosis is based on examination: impalpable testis and CT/MRI. The surgical correction of cryptorchidism is possible in childhood, but in adult orchiectomy is recommended, considering the malignancy risk. The association with hernia is uncommon. Material and Methods We report the case of a 23 years old male with left inguinal hernia and concomitant left cryptorchidism. MRI revealed the intra-abdominal left testicle, with reduced size and short vessels. Lab analysis were normal. We underwent laparoscopic exploration: the left testicle was small and had pelvic localization. A large inguinal hernia was also confirmed. We decided to perform laparoscopic TAPP (transaabdominal preperitoneal repair) and left orchiectomy. The evolution was uneventful and patient discharged 1st day postoperatively. Histology revealed testicular atrophy with no malignancy, also no spermatogenesis was present. No recurrence was found during follow-up. Results Cryptorchidism in adult is rare. The association with hernia is even more rare. The open management is not easy, often in pelvic/abdominal localization, the inguinal approach can be cumbersome. There is no standard of care for these cases, but we found the minimally invasive approach to be a good choice. Laparoscopic surgery has the advantage of enhanced exploration and orhidectomy can be easily performed. Associated with the orchidectomy, hernia cure can be facilitated by laparoscopic TAPP procedure. Conclusions In cases of concomitant hernia and cryptorchidism, we emphasize the idea of simultaneously cure hernia via laparoscopic TAPP procedure associated with orchidectomy as feasible and safe.

P146 ROBOTIC REPAIR OF COMPLICATED INGUINAL HERNIAS

Abstract Aim In this video, the authors provide an educational demonstration on the use of robotic surgery in management of two patients with complicated and recurrent inguinal hernias. The two patients demonstrated in these videos show the benefits of use of robotics in the approach to a patient with a recurrent hernia after previous open repair with plug and patch method as well as repair in a very obese patient with large hernias causing obstruction of the left ureter. Material and Methods N/a Results N/a Conclusions Robotic surgery is an emerging technology in surgery and can be a useful modality in treating patients with complex and recurrent inguinal hernias. Furthermore, the visualization in these complex cases can be helpful in identifying the important structures during dissection. Regardless of technique, the two videos presented demonstrate a complex dissection which may be needed when repairing recurrent or very large inguinal hernias.

A Novel Transabdominal Preperitoneal Hernioplasty Technique in the Repair of Large Inguinal Hernias: The use of Polypropylene Mesh in the form of Plug-patch.

To describe the outcome of modified transabdominal laparoscopic preperitoneal (TAPP) hernioplasty repair with plug-patch of polypropylene mesh. A descriptive study. Alanya Alaaddin Keykubat University Training and Research Hospital, Alanya, Turkey from December 2017 to December 2019. Patients aged 18-70 years, who underwent TAPP hernioplasty at this clinic between December 2017 and 2019 were evaluated retrospectively. Those with a defect diameter of 3 cm and above, which were measured intraoperatively, were considered as large inguinal hernias. A modified TAPP procedure that includes the plug-patch technique, using polyester mesh, similar to that of open inguinal hernia repair, was performed on these patients. Complications and recurrences frequency was noted. This modified TAPP procedure was applied to 35 patients (24 men, 11 women). The defect size was 3-4 cm in 24 patients, and 4 cm in 11 patients. None of the patients developed chronic pain. Five patients had a feeling of fullness in the inguinal region where the repair was performed, and their complaints subsided at the first month of follow-up. Seroma developed in 2 patients, but resolved spontaneously. During the follow-up period, no chronic complications or recurrences were observed. This technique is simple and does not create a serious cost burden on TAPP technique. Furthermore, it can be applied routinely with the advantages of low pain, rapid recovery and acceptable complication rates as well as the reduction of pseudo-recurrence rates. Key Words: Hernia, Laparoscopic repair, Plug-patch technique, Modified TAPP, Mesh.

Heavyweight Mesh Is Superior to Lightweight Mesh in Laparo-endoscopic Inguinal Hernia Repair: A Meta-analysis and Trial Sequential Analysis of Randomized Controlled Trials.

This meta-analysis and trial sequential analysis aims to provide an update on the available randomized controlled trials (RCTs) and recommendations on using lightweight mesh (LWM) or heavyweight mesh (HWM) in laparo-endoscopic inguinal hernia repair. LWM might reduce chronic pain through improved mesh flexibility and less fibrosis formation. However, in laparo-endoscopic repair chronic pain is already rare and LWM raise concerns of higher recurrence rates. A literature search was conducted in May 2019 in MEDLINE, Embase, and the Cochrane library for RCTs that compared lightweight (≤50 g/m2) and heavyweight (>70 g/m2) mesh in patients undergoing laparo-endoscopic surgery for uncomplicated inguinal hernias. Outcomes were recurrences, chronic pain, and foreign-body sensation. The level of evidence was assessed using GRADE. Risk ratios (RR) and 95% confidence intervals (CI) were calculated by random effect meta-analyses. Trial-sequential-analyses were subsequently performed. Twelve RCTs, encompassing 2909 patients (LWM 1490 vs HWM 1419), were included. The follow-up range was 3 to 60 months. Using LWM increased the recurrence risk (LWM 32/1571, HWM 13/1508; RR 2.21; CI 1.14-4.31), especially in nonfixated mesh direct repairs (LWM 13/180, HWM 1/171; RR 7.27; CI 1.33-39.73) and/or large hernia defects. No difference was determined regarding any pain (LWM 123/1362, HWM 127/1277; RR 0.79; CI 0.52-1.20), severe pain (LWM 3/1226, HWM 9/1079; RR 0.38; CI 0.11-1.35), and foreign-body sensation (LWM 100/1074, HWM 103/913; RR 0.94; CI 0.73-1.20). HWM should be used in laparo-endoscopic repairs of direct or large inguinal hernias to reduce recurrence rates. LWM provide no benefit in indirect hernias.

PE07 - Concurrent robotic radical prostatectomy and repair of bilateral, large inguinal hernias with mesh application

PE07 - Concurrent robotic radical prostatectomy and repair of bilateral, large inguinal hernias with mesh application

The efficacy of absorbable versus non-absorbable fixation in laparoscopic totally extraperitoneal (tep) repair of large inguinal hernias

Our study aims to compare clinical outcomes of laparoscopic Totally Extra-peritoneal (TEP) repair with mesh fixation in large inguinal hernias using titanium versus absorbable tacks. This is a case control study of patients who underwent laparoscopic TEP repair with mesh fixation of large inguinal hernias in our institution from 2010 to 2015. In all patients a standard 10×15cm large-pore polypropylene mesh was used and a standardized fixation technique was followed. Patient demographics, presentation, defect size as per the European Hernia Society Groin Hernia Classification, post-operative complications and recurrence rates were collected and analysed. 20 patients had mesh fixation with titanium tackers (Group TT) were compared with 37 patients who had mesh fixation with absorbable tacks (Group AT). Mean age was 57.00 (±13.78) in Group TT and 49.00 (±17.15) in Group AT. All patients were males. The median defect size was L3M2 in Group TT and L2M2 in Group AT. All patients were followed up for a mean period of 24 months (range: 1-48 months). Post-operatively, one patient in Group AT developed chronic pain. One Group TT patient and four Group AT patients developed seromas, which were treated conservatively. There were no recurrences in Group TT, while one Group AT patient developed a medial recurrence. Both titanium and absorbable tacks showed similar post-operative complications and pain scores. As such, they both appear safe and feasible for mesh fixation during laparoscopic repair of large inguinal hernias.

RESULTS OF THE USE OF VARIOUS METHODS OF ENDOSCOPIC INGUINAL HERNIORRHAPHY IN CHILDREN

Introduction. Endoscopic inguinal herniorrhaphy in children has become widespread, but there are no comparative results of using various technologies for its implementation. Material and methods. The results of 1136 laparoscopic herniorrhaphies in children for inguinal hernia throughout the period from 2006 to 2016 were analyzed. The first group (GL1) comprised 812 patients who underwent laparoscopic suturing of an inguinal hernia with intracorporeal purse-string suture. The second group (GL2) included 324 children, who were treated with the subcutaneous endoscopically assisted ligation (SEAL) technology - single-ported transcutaneous herniorrhaphy with laparoscopic assistance. Children were operated most often at the age from 1 year to 7 years. The average age of patients in the first group amounts of 4.6 years, in the second group - 4.5 years. All herniorrhaphies were performed standardly, with the use of the same instrumentation. Results. There were revealed such advantages of the use of the SEAL method as the time of training of beginning surgeons to the technique of endoherniorrhaphy is shorter by 2.5 times at the preclinical stage of training, at the stage of assisting and bringing the independent technique of its implementation to perfection; the duration of the operation is shorter due to the exclusion of the time for the introduction of the second/third port and the imposition of an intracorporeal node that presents the greatest difficulty for beginning surgeons; the number of intra- and early postoperative complications do not differ in both groups. The number of relapses is greater in GL2 children with large inguinal and scrotal hernias. The duration of hospitalization in groups did not differ. Conclusion. The use of SEAL technology is economically more profitable due to the relative simplicity of technique of herniorrhaphy and the minimal use of the number of endoscopic instruments. In large inguinal and scrotal hernias, it is more appropriate to use the traditional technique of imposing intracorporeal suture.