Methods Of Hernioplasty Research Articles

Etiopathogenesis of oblique inguinal hernia, new concept of its surgical treatment, postoperative complications and their correction

Objective. To study the results of applying a new conceptual approach to the surgical treatment of oblique inguinal hernia in order to reduce the frequency of its recurrence and preserve the function of the male reproductive system. Materials and methods. The study is based on the results of topographic and anatomical examination of 50 unfixed male cadavers on the 1st day after death. As clinical material, 144 patients who were inpatients in the surgical department were involved in the study. Results. Patients of the main group (n=71) underwent hernioplasty according to the developed method. The control group included 73 patients operated on by the Lichtenstein method. The etiopathogenetic basis of oblique inguinal hernia and the causes of its recurrence, the frequency of which after open and laparoscopic use of mesh implants is 5 – 15%, were studied. It is after the use of these implants in the Lichtenstein operation that a complication no less important than recurrence occurs, which is a decrease or even loss of male reproductive function. Conceptually, the new approach is to eliminate the deep inguinal ring, move the spermatic cord under the transverse fascia, and create a new inguinal ring. Conclusions. The proposed method of hernioplasty has significant advantages over the Lichtenstein method of surgery, which are to prevent recurrence of the disease and preserve male reproductive function.

Ранние и отдаленные результаты профилактики абдоминального компартмент-синдрома у пациентов с W3 вентральными грыжами

Abdominal compartment syndrome is a severe pathology requiring special preventive and treatment measures. The development of methods for the prevention of abdominal compartment syndrome is important in patients with W3 ventral hernias and loss of the domain. The study analyzed the results of treatment of 71 patients with W3 hernias of the anterior abdominal wall. Before surgery, all patients were calculated the size of the hernia implant necessary for the prevention of compartment syndrome. To calculate the size of the required hernia implant, radiography, ultrasonography and anthropometric data of the patient were used. The patients underwent hernioplasty with sublay, inlay and, developed by the authors, in a combined method. In the groups with inlay and combined method hernioplasty, the development of compartment syndrome was not observed. The combination of the developed methods of preoperative calculation of the hernia implant and the combined method of hernioplasty showed a low number of early and late postoperative complications, the same as in other study groups. The results obtained indicate the effectiveness of the developed methods for the prevention of abdominal compartment syndrome.

LAPAROSCOPIC TECHNIQUE FOR MEASURING THE ESOPHAGEAL HIATUS AREA

Introduction. The measurement of the esophageal hiatus (EH) area is critical for the choice of the method of hernioplasty for EH hernias. Aim. The objective of this study was to develop a laparoscopic method and tools for measuring the EH area and to compare it with existing methods in type III paraesophageal hernias (PEH). Materials and methods. Laparoscopic hernioplasty was performed on 63 patients with type III PEH – 41.3% males and 58.7% females, with an average age of 53.8±10.8 years, at the surgical clinic of the Bogomolets National Medical University. Irreducible PEH was present in 54 (85.7%) patients, partially reducible in 9 (14.3%). Cardia-fundal PEH was found in 42 (66.7%) patients, subtotal in 20 (31.7%), and total in 1 (0.6%) patient. The average volume of the hernial sac, according to multispiral computed tomography (MSCT), was 235±130.7 cm³ (ranging from 90 cm³ to 863 cm³). In all patients, the EH area was measured using the developed laparoscopic method (DLM) and tools; the Granderath method; the rhomboid area determination method (RAD); and MSCT. The authors evaluated the differences in the mean value and mean percentage difference (MPD) of EH area measurements between the mentioned methods. Results. The esophageal hiatus area measured using the DLM was statistically smaller than that measured by MSCT: 9.66±0.22 cm² versus 13.01±3.04 cm², respectively, and larger than the measurements from the Granderath method and the RAD: 8.16±1.71 cm² and 8.72±1.67 cm², respectively. The MPD between the MSCT data and the Granderath and RAD methods were 40.1±7.5% and 68.8±9.6%, respectively; between MSCT and DLM, it was 28.8±7.4%. The percentage difference in the esophageal hiatus area between the MSCT data and DLM, MSCT and Granderath, and MSCT and RAD showed a significantly positive correlation with the volume of the hernial sac, respectively r=0.687, r=0.601, and r=0.579. This indicates that with an increase in the volume of the hernial sac, the esophageal hiatus area calculated by MSCT increases compared to the intraoperative methods, likely due to the influence of the hernial contents on the area of the hernial orifice. Conclusions. The proposed laparoscopic method for measuring the area of the EH involves the use of a developed device that facilitates the removal of hernial contents from the hernial orifice, placing a ruler in their plane as a reference, transmitting the image to a computer, and calculating the area taking into account the individual shape characteristics. This method provides more accurate data compared to other intraoperative techniques and MSCT. Using the proposed laparoscopic technique for measuring the EH area will allow for a more thorough assessment of the indications for different hernioplasty options, considering the area of the hernial defect.

Clinical and experimental parallels in the substantiation of the method of hernioplasty of postoperative ventral hernias of median localization

Objective: development, clinical application of a new original method of hernioplasty of median postoperative ventral hernias and biomechanical experimental substantiation of the effectiveness of this method.Materials and methods: the method of hernioplasty of median postoperative ventral hernias with strengthening of fascial-aponeurotic structures of the anterior abdominal wall was developed and clinically tested on 63 patients. An anatomical experiment was performed in which the biomechanical parameters of the reinforced scar-altered structures of the median parts of the anterior abdominal wall were studied according to the method developed by us.Results: an increase in the biomechanical parameters of the median structures reinforced by the original method with a frame thread was found: the strength limit of the fascia — by 59.4%, and the modulus of elasticity — by 40.2%, compared with the scar-altered fascia in herniators. These results suggest a confident prevention of recurrence of herniation when using this technique. This assumption was confirmed after the introduction of the technique into clinical practice. In all 63 observed patients, there is no recurrence of herniation for 1-5 years. There were no significant complications of the course of the early postoperative period associated with the applied method of plastic surgery. The method is characterized by material and financial accessibility, the absence of complex technical manipulations that increase the duration of hernioplasty.Conclusions: the effectiveness in preventing recurrence of herniation, accessibility and simplicity of the proposed method of surgical treatment of postoperative and recurrent ventral hernias allows us to recommend it for wide clinical use.

Postoperative outcomes in patients after modified inguinal reconstruction: An observational cohort study

Background. Despite major progress in surgical care, the need remains to reduce the number of recurrences in the postoperative period in inguinal hernia patients and to improve their quality of life (QoL). To this end, the development of a technique for hernia repair, which would decrease dependence on the availability of consumables, appears promising. We present the surgical outcomes of inguinal hernia patients treated by the technique of tension-free hernioplasty using implants and auto-tissue flaps. Objective. To develop a technique for hernia repair with a reduced dependence on the availability of consumables, which could decrease the number of recurrences in the postoperative period in inguinal hernia patients and to improve their QoL indicators. Methods. An observational cohort study of 759 patients with inguinal hernias aged 18 years and older was conducted. The patients underwent treatment at the Ryazan City Clinical Hospital No. 11 and the Ryazan Region Clinical Hospital in the period from 2006 to 2022. The main group included 39 patients, who were operated by the Desarda technique modified by the authors. The modification consisted in the formation of a flap from the aponeurosis of the external oblique muscle, covering the seminal canal, with fixation of its free end to the inguinal ligament. The control group included 720 patients, 454 and 266 of whom were operated by the Bassini and Lichtenstein techniques, respectively. In order to evaluate the surgical outcomes, a comprehensive examination was performed, including collection of complaints, anamnesis, examination of the postoperative suture, and inguinal region. This included the size, shape, and hernia repairability, if any, dilation of the external inguinal ring, skin condition, painfulness and cough tremor at palpation, and ultrasound examination of the inguinal region. QoL was assessed using the SF-36 (Short Form) questionnaire. Statistical analysis was performed using the Statistica 13 software package (StatSoft, USA). Results. The patients of the main and control groups were divided into those who were admitted as planned and emergency patients. Long-term hernioplasty outcomes in the planned surgery patients were as follows: recurrences after the Desarda technique modified by the authors — 0 out of 24 (0.00%); recurrences after the Bassini technique — 44 out of 310 (14.20%); recurrences after the Lichtenstein technique — 7 out of 181 (3.87%). Long-term hernioplasty outcomes in the emergency patients were as follows: recurrences after the Desarda technique modified by the authors — 0 out of 15 (0,00%); recurrences after the Bassini technique — 31 out of 144 (21.53%); recurrences after the Lichtenstein technique — 4 out of 85 (4.70%). In the planned surgery patients of the main group, 5 QoL indicators were statistically significantly higher in relation to at least one method of hernioplasty of the control group. In the emergency patients, this number was 4 indicators. The absence of recurrences, both in planned and emergency patients, was associated with the non-invasiveness of auto-tissue, preserved non-tension, reduced dependence on the availability of consumables, and improved QoL of patients with inguinal hernias. These factors determine the advantages of the Desarda technique modification proposed by the authors. Conclusion. The application of the Desarda technique modified by the authors reduced the number of recurrences in the postoperative period in inguinal hernia in both planned surgery and emergency patients, improving their QoL. The suggested method of herniorrhaphy ensures reduced dependence on the availability of consumables.

Results of surgical treatment of patients of fertile age planning pregnancy with hernias of the anterior abdominal wall

BACKGROUND: Currently, there is no consensus and approved tactics for choosing the method of hernioplasty in the surgical treatment of patients of fertile age planning pregnancy with hernias of the anterior abdominal wall. The study is devoted to the comparative analysis of surgical treatment of these patients.
 AIM: To determine the algorithm of surgical treatment of hernias of the anterior abdominal wall in the patients of fertile age planning pregnancy.
 MATERIALS AND METHODS: The analysis of the treatment results of fertile age patients with hernias of the anterior abdominal wall in the period from 2010 to 2019 has been carried out. The inclusion criteria were as follows: patients of fertile age who underwent surgical treatment of hernias of the anterior abdominal wall, who did not have a relapse before pregnancy. Thus, 252 patients have been included in the study.
 RESULTS: The surgical tactics and optimal timing of the operation in patients of fertile age with hernias of the anterior abdominal wall have been determined.
 CONCLUSIONS: When planning surgical treatment of hernias of the anterior abdominal wall in patients of fertile age, it is necessary to clarify information about pregnancy planning. The most favorable period for planning pregnancy and childbirth is 3 years or more after hernioplasty. When planning a pregnancy in the next 12 years after surgical treatment of a ventral hernia, it is necessary to give preference to hernioplasty with local tissues, which has fewer complications in the long-term postoperative period as well as fewer relapses after childbirth compared with open prosthetic surgery. When planning a pregnancy 3 or more years after surgical treatment, preference should be given to prosthetic hernioplasty. When analyzing the results of treatment of the patients of fertile age with inguinal and femoral hernias, planning pregnancy, clinical experience has shown that there are no contraindications to performing laparoscopic transabdominal preperitoneal prosthetic hernioplasty.

ЭФФЕКТИВНОСТЬ ОТКРЫТЫХ ХИРУРГИЧЕСКИХ ВМЕШАТЕЛЬСТВ ПРИ ПАХОВЫХ ГРЫЖАХ У ПАЦИЕНТОВ ПОЖИЛОГО ВОЗРАСТА

Purpose. To evaluate the effectiveness of open methods of surgical treatment of inguinal hernia in elderly patients. Material and methods. The study includes 336 elderly patients with inguinal hernias. The Bassini hernioplasty was performed on 106 patients, the Liechtenstein technique was applied to 110 patients and the new tension-free method – to 120 patients. The effectiveness of hernioplasty was evaluated according to the results of the examination of patients in the early and remote postoperative periods, as well as the methodology for calculating the effectiveness of medical technologies in healthcare. Results. With open surgical interventions in patients with inguinal hernias in the early postoperative period there is an increase in the volume of the testicle on the side of surgery. In the remote period only after the Lichtenstein hernioplasty there was a decrease in the volume of the testicle (p<0.05). The relapse of the hernia (1-3 years later) after the Bassini hernioplasty took place in 9.4% cases, after the Liechtenstein hernioplasty - in 3.6% patients, and after applying the new method of hernioplasty there was no relapse of hernia. The new technique of tension-free hernioplastics was characterized by the highest level of medical (Km=1.00) and social efficiency (Ks=0.86). Conclusion. The new technique of open tension-free inguinal hernioplasty is characterized by the highest level of medical and social efficiency.

DIFFERENTIATED APPROACH IN VENTRAL HERNIA SURGERY

Relevance. The analysis of scientific, medical and patent documentation indicates that in the literature available to us there is no definition of indications for the use of one or another method of hernioplasty, taking into account various risk factors. The solution of these problems is an urgent and priority problem of modern herniology. Objective of the study: To develop a program for the choice of surgical tactics for ventral hernias. Research material. Based on the analysis of the results of surgical treatment of 228 patients with ventral abdominal hernias, the authors developed a program for scoring preoperative criteria that affect the choice of the optimal method of hernioplasty, taking into account the individual characteristics of the organism. Research results. In the main group of patients, we detected a relapse of the disease in one patient, which was 0.9% of the total number of patients examined in the long-term postoperative period. Relapse was noted in a patient from the 2nd subgroup who underwent hernioalloplasty with defect suturing. The relapse was caused by the insufficient area of the alloprosthesis. Findings. The scoring of perioperative risk criteria in patients with incisional ventral hernias allows choosing the optimal method of plastic surgery, taking into account the individual characteristics of the organism and improving the results of treatment. With pronounced apron-like deformity of the abdomen in obese patients, it is preferable to perform open hernioalloplasty with DLE.

Современные методы хирургического лечения пупочных грыж: обзор литературы

INTRODUCTION: In this review, methods of open and laparoscopic surgery of the umbilical hernia are described. Use of particular methods is substantiated depending on the size of the hernial orifice, the presence of hernia strangulation, diastasis of the abdominal rectus muscles, comorbidity, available technical equipment. Statistical data of complications, recurrences and of their prevention available in the literature are evaluated. The search for information was performed in electronic libraries: Pubmed, Cyberleninka. The inclusion time interval is 10 years. The keywords used in the search: umbilical hernia, IPOM, eTEP, (E)MILOS, SCOLA, tension method of hernioplasty, complications. The most important modern methods using endovideosurgical access are: laparoscopic IPOM(+), eTEP, (E)MILOS, SCOLA. Use of tension plasty can be justified in case of strangulation, but, here, recurrences are more common. The IPOM method has a number of disadvantages (adhesions, chronic pain, chronic seroma, recurrences), which make its use controversial and needing additional research. The eTEP-TAR, eTEP-RS methods are used in pronounced diastasis of the rectus muscles. The eTEP-RS method is convenient in simultaneous surgery of inguinal hernias. The eTEP-TAR method is used in case of large diameter of hernial orifice (5–12 cm), and suggested width of the retromuscular space less than 5 cm. The MILOS, EMILOS methods are used in case of primary, postoperative umbilical and epigastric hernias. With this, the frequency of complications is less relative to Sublay, IPOM. CONCLUSION: Each method of umbilical hernioplasty is based on certain factors taken into: diastasis of rectus muscles, size of hernial orifice, existence of strangulation, availability of equipment and materials, comorbid pathologies. The variety of manipulations determines personal approach in surgery of umbilical hernias. The modern tendencies in this field are minimization of injury rate in surgical approach in use of endovideosurgical access and attempts to perform simultaneous recovery of the muscular aponeurotic apparatus of the abdominal wall through elimination of diastasis of rectus muscle. Potentials of the modern high-tech medicine permit to significantly reduce the frequency of complications and recurrences in case of large, medium and complicated umbilical hernias.

Perioperative intra-abdominal pressure parameters for different surgical techniques in patients with ventral hernias

Aim. To study perioperative IAP parameters with various methods of hernioplasty in patients with ventral hernias.Materials and research methods. The results of the treatment of 148 patients with ventral hernias were studied. The first group included 58 patients for whom an anterior separation plasty was used for hernioplasty. The second group included 44 patients who underwent posterior separation of the abdominal wall muscles. The third group consisted of 46 patients who underwent onlay (n=28) and sublay (n=18) methods of hernioplasty.Results and discussion. In patients with W3 hernias, when closing the edges of the hernia orifice, there was a significant increase in IAP to a level corresponding to the I degree of intra-abdominal hypertension, which averaged 12.8±1.9 mm Hg (p<0.05). In patients with W4 hernias, the level of intra-abdominal pressure after closing the edges of the hernia orifice was significantly higher than in patients with W3 hernias, and on average they were 14.7±1.7 mm Hg. (p<0.05), which corresponded to the upper limit of the I degree of intra-abdominal pressure.Conclusion. The results of perioperative monitoring of intra-abdominal pressure indicate the tension nature of onlay and sublay hernioplasty methods, and therefore their use in hernias of W3 and W4 sizes is contraindicated. For large and giant hernias, the use of separation methods of hernioplasty is recommended.

Functional state of abdominal muscles in operative treatment of abdominal wall defects

The article presents the results of skin electromyography for 90 patients with umbilical hernias in combination with direct muscle diastasis, an assessment of the functional state of abdominal muscles before and after surgical treatment was carried out. The subjects were divided into two groups depending on the method of hernioplasty. The first group included 47 women (52,2%) the second group – 43 (47,7%) patients, each group was divided into a subgroup taking into account the size of the hernial defect and the stage of diastasis. In the formed groups, the functional state of the straight and lateral muscles was determined by recording amplitude and frequency during conditional contraction of the anterior abdominal wall. The study showed that the frequency of muscle contractions and the amplitude of fluctuations after surgical treatment in subgroups 1.1. and 1.2 was higher than subgroups 2.1. and 2.2 with respect to both the direct and lateral abdominal muscles. It was established that patients with umbilical hernias in combination with diastasis of the straight abdominal muscles need to perform combined hernioplasty in order to improve functional muscle activity and eliminate the imbalance between the straight and lateral muscles.

A Study of Enhanced View Total Extraperitoneal Laparoscopic Hernioplasty (E-tep) For Inguinal Hernia In Tertiary Care Hospital

Background: Generally, TAPP and TEP has been done, but it gives both technically less space to surgery and there is aneed to suture the mesh. In our new study we get more space to operate and no sutures required.Objectives: To study enhanced view total extraperitoneal laparoscopic hernioplasty (e-tep) for inguinal herniaMethods: The data for this prospective study was obtained from 21 patients undergoing Laparoscopic hernioplasty(21 from E-TEP) in Osmania General Hospital, Hyderabad, Telangana between November 2019 to May 2021 inclusiveof a follow up period of 6 months. Consent for the procedure was obtained. E-TEP procedure were performed usingPolypropylene mesh.Results: Minor complication rate was 26.66% for ETEP group. There was one case of converted from ETEP to TAPPmethod. The recurrence in E-TEP is zero. The hospital stay in E-TEP was 2.27 days.Conclusion: ETEP is the best method of hernioplasty for a primary inguinal hernia. However largescale study and longterm follow up studies are required.

TITLE OF THE ARTICLE: "MORPHOLOGICAL CHARACTERISTICS OF TISSUE TRANSFORMATIONS OF ALLOPLASTICS AND COMBINED HERNIOPLASTICS IN THE EXPERIMENT"

Introduction : There is a clear tendency to increase the number of patients with hernias and their surgical treatment, so there is an increasing numbers of postoperative complications : seroma, suppuration of postoperative wounds, mesh migration, pain, etc. The aim of the study : to create a new combined method of hernioplasty of complicated ventral hernias in the experiment and to investigate the morphological features of the tissue of the anterior abdominal wall. Materials and methods: Laboratory rats, namely 30 adult female rats of the breed Wistar, one age and weighing 200 250 g were kept in compliance with bioethical standards, in daylight for 12 hours, with a temperature of 210 С, the same degree of feeding "Coccidiostatic Premix", was divided into 3 groups of 10 individuals. On animals of group №1 (control) hernioplasty was performed with their own tissues, laboratory rats of group №2 were used for allogernioplasty with polypropylene mesh. Animals of group №3 were operated by a combined method, suturing of a hernia defect by fixing a polypropylene mesh 3x3 cm with single-knot sutures and then using a skin flap processed for 3-5 s in 960 С isotonic sodium chloride solution, deepithelizated and removed of subcutinious fats, and than implanted the epithelial side to the mesh and on top of it. Results: As a result of morphological analysis, there was a discrepancy in the lag of scar formation in the 2nd and 3rd groups compared to the 1st. At the same time, no significant morphological differences between the 2nd and 3rd groups were found. Conclusions: our proposed method of combining autodermoplasty and algernioplasty is a safe and effective method of hernioplasty.

Сравнительная оценка динамики иммунологической реактивности у пациентов послеоперационными вентральными грыжами

Postoperative Ventral Hernias to this day remain one of the main pathologies of planned and urgent surgical interventions. The purpose of the study is to study the immune response in patients with postoperative ventral hernias who underwent auto and alloplastic hernioplasty methods. The study included 40 patients diagnosed with postoperative ventral hernia, including 25 men (62.25%) and 15 women (37.5%). In men, the average age was 45.6±2.3 years, and in women 57.2±3.2 years. Patients are divided into 2 groups. Group I are patients who underwent autoplastic methods and group II patients who underwent alloplastic hernioplasty methods. The complex of immunological examination included the determination of a subpopulation of lymphocytes with CD3, CD4, CD8, CD20 receptors, interleukin 6, interleukin 10 and immunoglobulins A, M, G. Immunological examination of blood parameters in patients with postoperative ventral hernias revealed the following changes. There is an upward trend in all indicators. In group I, the leukocyte level was increased by +0.2±0.01, and in group II, the indicators were within the normal range. The level of monocytes in patients who underwent alloplasty increased by +1.5±0.2. There was an increase in the concentration of T and B lymphocytes with GD3, CD4, CD8, CD20 receptors on the 7th day after surgery in patients of the first group was +1.85±0.3, +1.6±0.4, +1.6±0.1, +1.5±0.2. And in patients of the second group, the initial level of indicators was lower and increased by +1.2±0.1, +1.4±0.2, +1.67±0.65, +1.03±0.45. The level of IL6 and IL 10 in the postoperative period increased in patients of the first group by +1.55±0.2 and +1±0.9, in the second group it was IL 6 +0.9±1.2, IL 10 +0.8±1.2. The study shows that the indicators of the humoral cell type tended to increase, which shows the result. Conclusions. Patients with postoperative ventral hernias who have undergone autoplastic and alloplastic hernioplasty methods in dynamics, the immunological reactivity indicators significantly increase on the 7th day, in comparison with the initial blood parameters. Namely, in patients who have undergone autoplastic methods of hernioplasty. The use of conventional suture materials in autogernioplasty increases the risk of developing an inflammatory process in the early and long-term postoperative period, in contrast to the use of polypropylene mesh prostheses.

COMPARATIVE ANALYSIS OF THE RESULTS OF PLASTIC INGUINAL HERNIA LAPAROSCOPIC AND TRADITIONAL METHODS

Purpose of the study. Conduct a retrospective comparative analysis of the results of laparoscopic and traditional methods of inguinal hernia repair, patients treated at the surgical departments at “A.N. Syzganov National Scientific Center of Surgery”, Almaty, Kazakhstan. Materials and methods. In the period from January 2017 to December 2020 137 patients were operated at the “A.N. Syzganov National Scientific Center of Surgery” in a planned manner for inguinal hernia and all patients were divided into 2 main groups: operated by traditional methods and laparoscopic method. Results.The data of the analysis suggests that the laparoscopic method of hernioplasty has an advantage over the traditional methods. Conclusion. Based on a comparative analysis of the indicators of patients in both groups, it can be concluded that the duration of the operation for laparoscopic hernia repair is 92.3 minutes, significantly more than with traditional methods, which is 79.4 minutes. Despite this, the duration of analgesic therapy in the postoperative period with laparoscopic hernia repair is 2.4 days, and the duration of hospital stay after surgery is 3 days, much less than with traditional methods, in which the duration of analgesic therapy in the postoperative period is 3, 3 days, and the duration of hospital stay after surgery is 4.6 days. This analysis suggests that laparoscopic hernioplasty has an advantage over traditional methods.

ПАХОВЫЕ ГРЫЖИ У ПАЦИЕНТОВ ПОЖИЛОГО ВОЗРАСТА. НОВЫЙ МЕТОД АТЕНЗИОННОЙ ГЕРНИОПЛАСТИКИ

Aim of the study. To develop a new method of tension-free inguinal hernioplasty in elderly patients, which will expand the arsenal of effective open methods of surgical treatment of inguinal hernias and improve the results of their treatment. Material and methods. A total of 172 elderly patients with inguinal hernias were treated. Hernioplasty according to the Lichtenstein method was performed in 83 patients, and according to the developed method – in 89 patients. The testicular volume and blood flow in a.testicularis were determined by ultrasound before surgery, in the early postoperative period, and 1 year after surgery. Results. The developed method of hernioplasty has the following advantages: 1) it permits to reduce significantly the contact area of the elements of the spermatic cord with a mesh implant; 2) the back wall of the inguinal canal is strengthened not only by the mesh implant, but the aponeurosis of the oblique abdominal muscle; 3) a window in a mesh implant corresponds to the diameter of the elements of the spermatic cord, 4) no decrease in testicular volume at the site of the operative intervention is observed in the late postoperative period. Conclusion. The proposed method of hernioplasty is simple to use and surpasses the well-known Lichtenstein method in a number of parameters.

Inguinal hernias in elderly patients. Strategy for choosing a surgical treatment method

Objective:to evaluate the existing approaches to the treatment of inguinal hernias in the elderly and to propose a strategy for choosing the method of surgical treatment taking into account the metric assessment of the state of the topographical and anatomical parameters of the inguinal canal.Materials and methods.The analysis of surgical interventions for inguinal hernias in elderly patients in surgical in-patient clinics of the Grodno region over 2018–2019 was carried out. The morphometric parameters of the inguinal canal being determinants for choosing the method of hernioplasty were studied in 39 elderly patients.Results.The coefficient for choosing the method of inguinal herniation (K) has been proposed. It is calculated by the formula: К = h : m, where h is the height of the inguinal space (mm), m is the total thickness of the upper wall of the inguinal canal (mm). At K>4.83 they choose atension methods of hernioplasty.Conclusion.The use of the coefficient for choosing the method of inguinal hernioplasty has made it possible to reduce the number of recurrent hernias in the long-term postoperative period from 5.7 % to 2.0 % of cases.

Assessment of Complications of Inguinal Hernia Surgery

Hernia repair is a frequent elective surgical operation. Unsatisfactory results in some cases have led to the persistence of a variety of different operative methods. Our study aimed to determine the frequency of postoperative complications with different surgery methods and evaluate the correlation of complications with patient characteristics and health. Materials and methods: We examined 403 patients with an inguinal hernia who underwent hernioplasty, including 98 by the method of Liechtenstein, 74 by the method of Gvenetadze, 231 by the laparoscopic method. Patients were aged 18-80 years with a mean age of 56.914.6 years. Statistical analysis was performed using SPSS 22. Results: The frequency of total perioperative complications of surgery was 52 (53.06 %), according to the method of Lichtenstein, 13 (17.57%) according to the method of Gvenetadze, and 23 (9.96 %) according to laparoscopic surgery. The following postoperative complications were observed: damage to the colon, bleeding from the lower epigastric vessels, urinary retention, neuralgia, hematomas, and delayed postoperative wound healing, higher in patients undergoing Lichtenstein surgery (p <0.05). The Liechtenstein method significantly increases the likelihood of complications; odds ratio OR=8.23 (95% CI: 4.87-13.94), with the Gvenetadze method, the relative chance decreases insignificantly OR=0.722 (95% CI: 0.30-1.39), with the laparoscopic method, the relative chance of complications are significantly reduced OR=0.20 (95% CI: 0.12- 0.34). Conclusions: The odds ratio of postoperative complications of hernioplasty increases with the Liechtenstein method and decreases with laparoscopy. A comparison of the open methods of hernioplasty shows an advantage of the Gvenetadze method over the Liechtenstein method.

ИНТРАОПЕРАЦИОННАЯ ОЦЕНКА ТОПОГРАФО-АНАТОМИЧЕСКИХ ПАРАМЕТРОВ ПАХОВОГО КАНАЛА ПРИ ГРЫЖАХ И ЕЕ ЗНАЧЕНИЕ В ВЫБОРЕ МЕТОДА ГЕРНИОПЛАСТИКИ

Purpose. To give a comparative description of the topographic and anatomical parameters of the inguinal canal in hernias and to evaluate its importance in choosing a method of hernioplasty. Material and methods. In 120 patients with types II, IIIa, IIIb inguinal hernias, the height of the inguinal space (h-IS), the total thickness of the internal oblique and transverse abdominal muscles forming the upper wall of the inguinal canal (TMT) and the diameter of the deep inguinal ring (DDIR) were measured intraoperatively. Results. Pairwise comparisons of the IS height revealed statistically significant differences in this parameter between hernias types II and IIIa, as well as between types II and IIIb (p = 0.0432) in all age groups. In the studied age groups, there were statistically significant differences in the diameter of the deep inguinal ring between patients with hernias types II and IIIa, as well as types II and IIIb (p <0.001). The TMT of the upper wall of the IC in all age groups did not depend on the type of inguinal hernia and was associated with the patient's age. Conclusion. Intraoperative morphometry is an objective method for assessing the topographic and anatomical parameters of the inguinal canal and should underlie the choice of the method of tension or tension-free inguinal hernioplasty during open surgical interventions.

Иммунологическая реактивность организма на имплантированные сетчатые эндопротезы, используемые при грыжах передней брюшной стенки

The article analyzes the review of the literature of foreign authors and authors of the CIS countries on the immunological response to the used mesh endoprostheses in patients after alloplastic methods of hernioplasty with hernias of the anterior abdominal wall. Currently, it is possible to monitor the course of the wound process in patients operated on for hernia using the immunological method. The correlation dependence of the nature of complications in the wound with indicators of additional research methods has not been sufficiently studied, which requires further study of this issue.