Surgical Treatment Of Inguinal Hernia Research Articles

CONSIDERATIONS ON EMBRYOLOGY, ANATOMY AND CLASSIFICATION OF INGUINAL HERNIAS IN CHILDREN

Appropriate surgical treatment of inguinal hernia in children requires an extensive review of the embryological developmental and anatomical aspects of the inguinal canal and hernial sac. The given paper represents a broad survey of data from the literature, predominantly from recent years, and incorporates information on the knowledge of anatomy, embryology and classification of inguinal hernias, which have direct clinical implication in surgery for hernia, hydrocele and undescended testis in children.

Comparative analysis of comorbidity, surgical complications, pharmacotherapeutic needs, and rehabilitation requirements in transabdominal preperitoneal hernia repair versus conventional operative treatment—current results and benefits

Background: Laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair is a relatively new method of inguinal hernia surgical repair that, at theory, provides a good view of the inguinal anatomy and sac contents and, as a laparoscopic procedure, is considered less invasive and with fewer complications compared to total extraperitoneal (TEP) inguinal hernia repair. Purpose: This study aims to assess the short-term outcome of laparoscopic transabdominal preperitoneal inguinal hernia (TAPP) repair. Material and methods: The retrospective clinical data for 138 patients with unilateral and bilateral hernia, operated in the Department of General, Visceral, and Emergency Surgery of the University Emergency Medicine Hospital ‘N. Pirogov’ from 01 January 2022, to 01 January 2023, were included. The risk profile of the patients, the intraoperative and postoperative complications, the duration of hospital stay, the frequency, and the type of analgesics used were analyzed. Results: Forty-one women (29.7%) were included; men comprised 97 (70.29%) of the cohort. Of the selected group, 63 (45.7%) patients had indirect inguinal hernias, 34 (24.6%), and 25 (18.1%) were diagnosed with direct inguinal hernia and accreta inguinal hernia, respectively. A history of repeatedly occurring hernias was found in 16 patients (11.6%). The average hospital stay was 32 hours (or 1.3 days) and ranged from 24 hours (1 day) to 48 hours (2 days). Complications occurred in 11 (7.97%) patients. The need for analgesics and anti-inflammatory agents was reliably reduced compared to the patients undergoing conventional surgical treatment of inguinal hernia. The patients were followed for three months post-discharge for the occurrence of surgical morbidity associated with the TAPP hernia repair. None of the patients used an antimicrobial agent, as indicated by a possible complicating bacterial infection. Rehabilitation was started within the first 12 hours after the operation, thus contributing to a significantly shorter hospital stay compared to patients undergoing conventional surgical repair of an inguinal hernia. Conclusion: Our results demonstrate that TAPP inguinal hernia repair is a safe procedure with reduced postoperative pain. It has fewer complications, with no significantly longer operative time and a shorter overall hospital stay.

Polyurethane-based three-dimensional printing for biological mesh carriers

Repair and reconstruction of the myopectineal orifice area using meshes is the mainstay of surgical treatment of inguinal hernias. However, the limitations of existing meshes are becoming increasingly evident in clinical applications; thus, the idea of using three-dimensionally (3D)-printed biological meshes was put forward. According to the current level of the 3D printing technology and the inherent characteristics of biological materials, the direct use of the 3D printing technology for making biological materials into finished products suitable for clinical applications is not yet supported, but synthetic materials can be first printed into 3D form carriers, compounded with biological materials, and finally made into finished products. The purpose of this study was to develop a technical protocol for making 3D-printed biomesh carriers using polyurethane as a raw material. In our study: raw material, polyurethane; weight, 20–30 g/m2; weaving method, hexagonal mesh; elastic tension aspect ratio, 2:1; diameters of pores, 0.1–1 mm; surface area, 8 × 12 cm2; the optimal printing layer height, temperature and velocity were 0.1 mm, 210–220 °C and 60 mm/s. Its clinical significance lies in: (1) applied to preoperative planning and design a detailed surgical plan; (2) applied to special types of surgery including patients in puberty, recurrent and compound inguinal hernias; (3) significantly improve the efficiency of doctor-patient communication; (4) it can shorten the operation and recovery period by about 1/3 and can save about 1/4 of the cost for patients; (5) the learning curve is significantly shortened, which is conducive to the cultivation of reserve talents.

A comparison of post-operative parameters between the Shouldice methods modified according to Berliner darn and the Lichtenstein method in the repair of inguinal hernias

Introduction: Surgical treatment of inguinal hernia is one of the most common procedures in surgery. Various techniques can be used to repair inguinal hernias, but the two most commonly used are the Shouldice surgical technique, modified by the Berliner Darn and Lichtenstein techniques, as a non-extension technique. However, despite the long tradition of surgical hernia treatment, there is still no consensus on the best or most appropriate surgical technique for elective inguinal hernia repair. Therefore, it remains a challenge for surgeons to choose the appropriate hernia repair method on a case-by-case basis that results in low complications and faster recovery. The aim of this study is to compare the efficiency of the Shouldice surgical technique modified by the Berliner Darn and Lichtenstein techniques in the treatment of hernias with respect to certain post-operative parameters. Methods: A prospective and cohort study was conducted at the Clinical Hospital in Tetovo. The study included 100 patients diagnosed with inguinal hernia and treated in hospital. The monitored patients were divided into two groups according to the technique used: 50 patients treated with Shouldice technique modified by Berliner Darn and 50 patients treated with Lichtenstein technique. In addition, we based the selection of the groups mainly on the reproductive age of the patients. Only male patients were treated in both groups, as there were very few female cases during the study period. Results: Patients operated on with the Lichtenstein technique were more mobile postoperatively, post-operative pain was less severe and return to daily and occupational activities and length of hospital stay were significantly shorter than with the Shouldice technique. Conclusion: The Lichtenstein tension-free surgical technique is more efficient and adequate than the modified Shouldice technique according to Berliner Darn in terms of post-operative pain intensity, length of hospital stay, return to daily activities, and return to work.

Management of Inguinal Hernia in Adults in a Community Setting: The Case of the Commune I Reference Health Center of Bamako

The aim was to study and analyse the results of surgical treatment of inguinal hernia in a community setting. We conducted a prospective descriptive study from 1st January 2021 to 31 December 2021 in the general surgery department of the Commune I referral health centre. A total of 74 patients underwent surgery for inguinal hernia. Inguinal hernia accounts for 6% of surgical consultations. Males were the most represented, with a sex ratio of 13.3; the mean age was 50.39, with extremes ranging from 18 to 86 years. Farmers, shopkeepers and workers accounted for 46%. In 40.5% of cases, patients consulted for inguinal swelling. Preoperatively, the hernia was complicated in 13.5% (10) of patients. Hernial strangulation was the main preoperative complication in 13.5% (10). Treatment was essentially surgical; local anaesthesia was used in 75.7% of our patients, general anaesthesia in 5.4% and locoregional in 18.9%. The Shouldice technique was used in 99% of cases, the operative follow-up was simple in 44.6%, and the presence of keloids in 1.4%. Conclusion: The Shouldice technique was the technique of choice for inguinal hernia repair in community settings in developing countries because of its results and its affordability compared with other techniques using medical devices.

V-014 TIPS AND TRICKS OF INGUINAL HERNIA SURGICAL MANAGEMENT IN SUB-SAHARAN AFRICA COOPERATION CAMPAIGNS

Abstract Introduction and Aim Inguinal hernia is the most prevalent surgical pathology in every surgery department. However, in the African continent (especially the Sub-Saharan region), the shortage of surgeons and the population's difficulty in accessing medical care have made herniary pathology a very frequent cause of disability in the young population. That is why foundations such as “Hernia International” and “Cirujanos en acción” carry out numerous cooperation campaigns each year, in which surgical treatment of inguinal hernia is the key as it meets the four ideal requirements: high prevalence, high impact of surgical treatment, few serious postoperative complications and the possibility of operating on many patients with few resources.The standard surgery in this setting is the Lichtenstein type hernioplasty with sac ligation for L3EHS type hernias.But we believe that the preperitoneal approach through the anterior access (Berliner technique)also has an indication that the general surgeon should know. Material and Methods We present the two surgical approaches that we use in cooperation campaigns, analyzing the technical tricks for the management. 1.They are mostly L3 hernias with large chronic scrotal sacs due to persistent peritoneo-vaginal processes of long evolution; 2.High sac ligation is a resource that will reduce the risk of recurrence; 3.The Lichtenstein technique is the standard approach used when the posterior wall is acceptable and the deep inguinal orifice is less than 3cm; 4.In the rest of the cases,the Berliner technique is a technique with excellent long-term results and that the surgeon who operates hernias on the African continent should master.

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.

The first experience of using Reperen-10-2 mesh with fixation Glubran-2 glue for minimally invasive surgical treatment of inguinal hernias

The first experience of using Reperen-10-2 mesh with fixation Glubran-2 glue for minimally invasive surgical treatment of inguinal hernias

Effect of COVID-19 pandemic on surgical treatment of inguinal hernia: A retrospective study

Aim: In this study, we aimed to examine the effect of the COVID 19 pandemic on the number, complication rates and epidemic characteristics of patients operated with the diagnosis of inguinal hernia in our institute.
 Methods: We analyzed all patients who underwent inguinal hernia operation in Trakya University Faculty of Medicine, Dept of General Surgery, between March 11, 2019, and March 11, 2020, and compared them with the cases between March 11, 2020, and March 11, 2021, retrospectively. Percentages, mean, standard deviation, median and interquartile range were used as the descriptive statistics. Mann-Whitney U test was used for the variations which are contrary to the normal distribution range in the comparison of two groups. The relations between qualitative variations were studied by the Pearson Chi-Square test and Fisher's Exact test. Significant value was determined as 0.05 for all statistical analyses.
 Results: Between March 11, 2019, and 2020, 65 patients were operated on (Group 1), and 26 patients between March 11, 2020, and 2021 (Group 2). The percentage of female patients was significantly higher in Group 2 (4.6% in Group 1, 23.1% in Group 2, p=0.008) and there was a statistically significant increase in the rate of incarceration and strangulation in Group 2 (44.6% in Group 1, 84.6% in Group 2, p=0.001).
 Conclusions: During the COVID-19 pandemic the incarceration and strangulation rate was higher. The increase in complication rates can be attributed to the relative decrease in elective surgeries or the increase in the number of female patients admitted during the COVID period.

DEVELOPMENT OF THE TAILORED APPROACH IN INGUINAL HERNIA REPAIR

The aim of the study is to evaluate the effectiveness of a personalized algorithm for determining the technique of surgical treatment of inguinal hernias, which allows choosing the optimal operational tactics (its modifications) depending on the anthropometric, clinical, instrumental data of the patient.In the course of the study, the results of the application of a clinical algorithm in the Medical research and Educational center of Lomonosov Moscow State University for patients with unilateral non-incarcerated symptomatic inguinal hernias were analyzed. The frequencies of the main postoperative adverse outcomes of the research group were compared using the algorithm and patients of the German Herniamed Hernia Register, for whom only standard principles of surgical intervention selection are applied, the main provisions of the recommendations of the international HerniaSurge Group of experts. In some cases individual exceptional factors of patients were taken into account.The frequency of chronic pain and pain requiring repeated surgery was significantly lower than the average frequencies of the German Herniamed register (13.8% vs 28.7% (p<0.00001) and 0.99% vs 3.8% (p=0.0103) respectively). At the same time, the frequency of adverse outcomes, such as relapses and early postoperative complications, is similar to international population data.

CHOICE OF INGUINAL HERNIA REPAIR PROCEDURE

Introduction. Modern surgical approaches to inguinal hernia repair are laparoscopic (TAPP and TEP) and open (Lichtenstein procedure), which are based on prolene mesh prosthetics. Despite the widespread use of these methods of hernia repair in surgical practice, the frequency of typical postoperative complications: hematoma of the scrotum and inguinal region, false recurrence, paresthesias, neuralgia, etc.
 Aim. To compare TAPP, TEP, and Lichtenstein based on analysis of long-term treatment outcomes.
 Materials and methods. We performed surgical treatment of inguinal hernia in 211 patients. All of them underwent tension-free hernia repair using a prolene prosthesis. Lichtenstein procedure was performed in 65 patients (Lichtenstein group), TAPP (TAPP group) in 81 patients and TEP (TEP group) in 65 patients. In 30 patients of different groups, the blood flow in the vessels of the testis was studied after the procedures performed within 45–60 days.
 Results. Probably (p<0.001) faulty recurrence was observed more often in the Lichtenstein group. Seromas that persisted for more than 30 days (p<0.01) and seromas that required surgical intervention — puncture (p<0.05) were more likely to be noted in the TEP group. Indicators such as hernia recurrence (up to one year) and the intensity and frequency of chronic postoperative neuralgia in the Lichtenstein, TAPP and TEP groups differed improbably. The systolic velocity of blood flow in the vessels of the testis in patients of the Lichtenstein group before the operation was (19.70±3.53). In the postoperative period, an incredible decrease in blood flow was observed (19.28±3.41). In patients of the TAPP group, the preoperative systolic velocity was (19.83±3.27) and improbably decreased to (19.47±3.44) within 45–60 days. A similar improbable decrease was observed in the TEP group — (19.80±3.56) and (19.63±3.51)
 Conclusions. The Lichtenstein procedure and endoscopic methods of inguinal hernia correction (TAPP and TEP) are safe procedures in terms of long-term complications and do not likely affect the systolic blood flow velocity in the testicular arteries.

Quality of life of patients after inguinal hernia repair

Introduction. Endoscopic procedures for inguinal hernia repair have become widespread. There are many methods of such treatment: transinguinal preperitoneal mesh-plasty (TIPP), TAPP, TEP, MINI (combination of TEP and TAPP). However, the most common among them are TAPP and TEP. Despite the fact that these procedures are now common in many hospitals, the choice of tactics and repair procedures for different types of inguinal hernias is still uncertain. First, it concerns the quality of life of patients.
 Aim. The aim of this study was to compare TAPP, TEP and Lichtenstein based on quality of life analysis using the EuraHS-QoL scale.
 Materials and methods. We performed surgical treatment of inguinal hernia in 211 patients. Lichtenstein's procedure was performed in 65 patients (Lichtenstein group), transabdominal preperitoneal (TAPP) inguinal hernia repair in 81 patients (TAPP group) and totally extraperitoneal (TEP) inguinal hernia repair in 65 patients (TEP group). We assessed quality of life using a special scale for hernias (EuraHS-QoL). The missing values were treated according to the instructions of the validation study.
 Results and discussion. As we expected, inguinal hernia repair improved EuraHS-QoL scores in all groups. In the Lichtenstein group, the total mean decreased from 51.2 to 11.8 (4.3 times) (r=-0.13), in the TAPP group – from 51.1 to 9.9 (5.2 times), in the TEP group – from 51.2 to 12.6 (4.1 times). Cosmetic discomfort was highest at the follow-up visit in patients in the Lichtenstein group (4.2). In the TAPP group, this indicator was probably (p<0.05) the smallest (3.0). Low-traumatic methods of operations in modern surgery are priorities today. The Lichtenstein procedure, despite its simplicity, is a traumatic operation compared to TAPP and TEP.
 Conclusions. Different options for inguinal hernia repair, which are based on the tension-free principle of inguinal canal correction, can be useful. However, when we analyzed the quality of life according to the EuraHS-QoL scale, we decided that transabdominal preperitoneal (TAPP) inguinal hernia repair is the most optimal in terms of various indicators.

The use of nanomodified polypropylene mesh with an antiseptic in patients with inguinal hernias during Lichtenstein surgery

Aloplasty of inguinal hernias (IH), of using modified polypropylene mesh antiseptic and an by carbon nanotubes, buth this is accompanied by a fairly high freguency of postoperative complications from the postoperative wound.
 In our view, the use of a nanomodified polypropylene mesh modified by carbon nanotubes and an antiseptic of polyhexamethleneguanidme chloride the results of surgical treatment of IH.
 Aim – to improve the results of surgical treatment of inguinal hernias modified polypropylene mesh antiseptic and an by carbon nanotubes.
 Materials and methods. The analysis of surgical treatment of 144 patients with IH of has been performed. Depending on the type of mesh used during surgical treatment, patients were divided into 2 groups. In 72 (50%) of Group I patients, using modified polypropylene mesh antiseptic and an by carbon nanotubes. In the 2ndgroup, 72 (50%) patients using classic polypropylene mesh.
 Results and discussion. Statistically significant results were obtained in patients of Group I compared to Group II: seroma was in 4 (5.6±1.2%) in Group II compared to 2 (2.8±0.4%) in Group I (p<0.05), respectively, the suppuration of the postoperative wound – 4 (5.6±0.4%) to 1 (1.4±0.6%) (p<0.05). The terms of stay of patients of group II on inpatient treatment – 11,2±2,2 days group II – 7,3±1,3 days.
 Long-term results: ligature fistulas of the anterior abdominal wall were detected in 3 (5.4±0.4%) patients of group II, in patients of group I of the ligature fistulas were not detected (p<0.05), meshoma – in 1 (1.8±0.3%) of patients in group II, in group I there was no stir (p>0.05). Chronic pain in the abdominal wall in 6 – 8 months after surgery was observed in 3 (5.4±0.4)% patients in group II and in 1 (1.8±0.5%) group I (p>0.05), recurrences of hernia were found in 3 (5.4±0.4%) patients of group II, in group I – in 1 (1.8±0.3)% (p<0.05).
 Conclusion. Surgical treatment of IH using modified polypropylene mesh antiseptic and an by carbon nanotubes the use of the classical polypropylene mesh, namely, reducing the freguency of seroma from 5.6±1.2% in the II group of patients to 2.8±0.4% in group I, respectively, suppurations of postoperative wounds – from 5.6±0.4% to 1.4±0.6%, inflammatory infiltrates – from 5.6±0.4% to 1.4±0.6%, ligaturial fistulas of the anterior abdominal wall – from 5.4±0.4% to 0%, meshoma – from 1.8±0.3% to 0%, chronic postoperative pain – from 5.4±0.4% to 1.8±0.5%, recurrence of hernia–from 5.4±0.4% to 1.8±0.3%.

CHOICE OF INGUINAL HERNIA REPAIR PROCEDURE

Although many surgeons now prefer the Lichtenstein operation, the optimal technique for inguinal hernia repair remains controversial. Although many studies have compared Lichtenstein, TAPP and TEP operations, there is no single solution. Therefore, in our work, we considered and analyzed the effectiveness of the treatment of inguinal hernias with these three currently recommended methods.
 Aim. To compare TAPP, TEP, and Lichtenstein based on analysis of immediate treatment outcomes.
 Materials and methods. We performed surgical treatment of inguinal hernia in 211 patients. All of them underwent tension-free hernia repair using a prolene prosthesis. Lichtenstein procedure was performed in 65 patients (Lichtenstein group), TAPP (TAPP group) in 81 patients and TEP (TEP group) in 65 patients.
 Results. The time of operation in patients of different groups differed improbably, although this indicator was the highest in the TEP group. Length of hospital stay was lowest in the Lichtenstein group and highest in the TEP group, although no statistical significance was observed. The terms of outpatient treatment were improbably the lowest in the TAPP group and the highest in the TEP group. The lack of statistical probability between these analyzed indicators allowed us to state that all procedure for inguinal hernia did not differ in terms of operation time and terms of postoperative medical, social and physical rehabilitation. The frequency of inguinal hematoma, subcutaneous emphysema, and seroma was probably (p<0.05) highest in the TEP group. Shoulder scapular pain syndrome occurred more often in the TAPP group (p<0.001). The frequency of development of other complications between patients of all three groups differed improbably. When TAPP was performed, in comparison with only TEP, shoulder scapular pain syndrome probably developed more often (OR 10.06, 95 %, CI 1.26–80.10, p = 0.019; χ2 = 5.43), however, the frequency of subcutaneous emphysema (OR 0.57, 95 %, CI 0.24–1.36, p=0.29; χ2=1.10) and hernia recurrence (OR 1.62, 95%, CI 0.14–18.28, p = 0.84; χ2 = 0.04) differed improbably.
 Conclusions. We did not notice significant differences in the duration of the operation, the frequency of postoperative complications, the length of stay in the hospital, and the recovery of work capacity and quality of life when using the currently recommended methods of inguinal hernia repair. This makes it possible to choose a method of hernia treatment, focusing more on anesthetic contraindications and concomitant diseases.

Study on Different Surgical Treatment of Inguinal Hernia

Study on Different Surgical Treatment of Inguinal Hernia

Clinical and anatomical rationale for the use of simple methods of inguinal hernia repair

Despite significant advances in the field of surgical treatment of inguinal hernias, its results cannot be considered completely satisfactory. This is evidenced by the damage to the intestines, bladder, testicular atrophy and relapses arising from hernia repair.

Післяопераційний стан пацієнтів у результаті лікування пахових гриж лапароскопічним та відкритим методами

Purpose – to analyze condition of patients after surgical treatment of inguinal hernias by laparoscopic and open methods. Materials and methods. A retrospective review of medical histories and outpatient charts of all patients who underwent inguinal hernia surgery at the Kyiv City Clinical Hospital No. 1 from January 2018 to July 2020 was conducted. Results. During the above period of time in our hospital open hernioplasty was performed in 86 patients, laparoscopic hernioplasty – 138 patients. With open hernioplasty, the average duration of surgical treatment was 40±12 minutes. The laparoscopic technique was 35±12 minutes. The length of hospital stay was significantly longer in the group of patients with the open method (48±12 hours) than in the group of laparoscopic plastic surgery (12±3 hours). From the group of patients who underwent open hernioplasty, 62 patients complained of long-term pain syndrome, from the group of laparoscopy – 12 patients. The cosmetic appearance was dissatisfied with 34 patients in the open access group and only 2 patients in the laparoscopic plastic group. Postoperative complications were observed in 34 patients who underwent surgical treatment through open access, and in 15 patients – by laparoscopy. Conclusions. The laparoscopic approach of inguinal hernia surgery is superior to open access, as it reduces the length of hospital stay, postoperative recovery, improves the aesthetic effect of the operation, reduces the frequency of infection of incisions. According to the results of the study, this technique gives a better result in the early postoperative period, a lower percentage of chronic pain and a higher degree of patient satisfaction compared to open access with the same low recurrence rate. Therefore, in our opinion, laparoscopic access to hernioplasty is the optimal method of treatment and can be recommended as a method of choosing inguinal hernia surgery. Postoperative assessment of the quality of life of patients after treatment of inguinal hernia by laparoscopic and open methods. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: inguinal hernia, laparoscopy, open access surgery, analysis of methods, operation.

Хірургічна корекція пахвинних гриж в дітей із застосуванням міні-інвазивного методу PIRS

Вступ. Пахвинна грижа (ПГ) — одне із найбільш поширених захворювань дитячого віку, що вимагають хірургічного лікування. Основним показанням до оперативного лікування ПГ є ризик її защемлення. Серед способів лапароскопічної герніорафії особливо перспективним є метод PIRS (percutaneous internal ring suturing). Мета роботи — провести аналіз власного клінічного матеріалу хірургічного лікування ПГ у дітей із використанням методу PIRS. Матеріали та методи. У дослідження включено 62 дитини з ПГ віком від 2 місяців до 7 років, яких прооперували впродовж 2012–2015 років методом PIRS з ушиванням внутрішнього кільця пахвинного каналу. Серед пацієнтів було 48 (77,4 %) хлопчиків і 14 (22,6 %) дівчат. Правобічну грижу діагностовано в 45 (72,6 %) хворих, а лівобічну — у 10 (16,1 %). Двобічну ПГ перед операцією діагностовано в 7 (11,3 %) дітей. Для оперативних втручань використовували прямий або 30° лапароскоп 5 мм.Результати та обговорення. Серед переваг лапароскопічних методів, і зокрема способу PIRS, виділяють можливість виявлення незарощення вагінального паростка очеревини з контралатерального боку. Так, у 6 (9,7 %) хворих розширення внутрішнього кільця пахвинного каналу з протилежного боку візуалізовано інтраопераційно. Також перевагами цього методу є використання лише одного оптичного порту діаметром 3–5 мм та відсутність потреби в накладанні інтракорпоральних швів. Жоден оперований пацієнт при застосуванні нитки Ethibond* Excel 2–0 не скаржився в післяопераційному періоді на неприємні відчуття в ділянці післяопераційного вузла, що розміщували підшкірно в пахвинній ділянці. У дослідженні рецидив ПГ виявлено в 2 (3,2 %) хлопчиків. Цих пацієнтів повторно також прооперовано з використанням методики PIRS. Висновки. PIRS — простий та ефективний міні-інвазивний метод хірургічної корекції ПГ, що дає добрий косметичний результат. Застосування лапароскопічного методу в лікуванні ПГ у дітей дозволяє ретельно оглянути внутрішні кільця пахвинних каналів і, за потреби, виконати корекцію вади з обох боків. Використання нитки Ethibond* Excel 2–0 для ушивання внутрішнього кільця пахвинного каналу є ефективним та дає оптимальні функціональні результати. Ризик рецидиву ПГ після операції методом PIRS є порівнянним з ризиком рецидиву після операції класичним методом.

Hybrid method using laparoscopy and Lichtenstein's technique for incarcerated inguinal hernia in a patient with liver cirrhosis and severe varicose veins: A case report.

IntroductionCirrhosis is a significant determinant of postoperative morbidity and mortality. Patients with severe liver cirrhosis are substantially contraindicated for surgical treatment of inguinal hernia because of the substantial recurrence rate and high postoperative morbidity and mortality. However, hernia with incarceration and strangulation, which could become life-threatening, should be repaired urgently even for patients with severe liver cirrhosis. No clear surgical guidelines have been established regarding the treatment strategy for inguinal hernia in patients with cirrhosis.Presentation of caseA 62-year-old man with a history of chronic C-type liver cirrhosis (Child-Pugh classification C) and hepatocellular carcinoma was referred to us for surgical treatment of an irreducible right inguinal hernia. An abdominal computed tomography (CT) scan revealed that the small intestine had herniated into the scrotum and severe abdominal wall varicose veins due to liver cirrhosis. We performed a hybrid method that combines examination laparoscopy and Lichtenstein's technique to observe the abdominal cavity and to avoid the risks due to severe varicosis of the inferior epigastric vein.DiscussionThere have been some reports of inguinal hernia with cirrhosis and ascites, but no reports of incarcerated inguinal hernia with abdominal wall varicose veins. In the present case, we chose a laparoscopic approach to observe the abdominal cavity to confirm intestinal necrosis. Hybrid surgery using laparoscopy and Lichtenstein's technique for incarcerated inguinal hernia could be performed safely.ConclusionHybrid surgery using laparoscopy and Lichtenstein's technique may be an effective method for patients with incarcerated inguinal hernia with end-stage cirrhosis and severe abdominal varicosis.

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.