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AN IMPROVED METHOD OF NON-TENSION HERNIOALLOPLASTY
FOR INGUINAL HERNIAS
Khujamov Olimjon Bakhridinovich
Atoyeva Mokhigul Otabekovna
Usmonov Amirbek Usmonovich
Arziyev Asilbek Ismoilovich
Saymurodova Shaxnoza Ziyodullayevna
Bukhara State Medical Institute, Republic of Uzbekistan, Bukhara
https://doi.org/10.5281/zenodo.13828654
Introduction.
Lichtenstein's "non-tensioned" technique of inguinal
hernioalloplasty has shown a number of obvious advantages over traditional
types of inguinal hernia repairs. The operation takes a little time, is easy to
perform and is quite acceptable in terms of cost [6]. However, often the inguinal
ligament is so loose that it can hardly be a reliable place for fixation of the
prosthesis. There is a need for additional fixation. The use of the Cooper
ligament for this purpose, as recommended by many authors, only partially
solves the problem, while the Kozlov techniques with the formation of an
artificial inguinal ligament and Fletching with the use of a "three-layer mesh" are
technically complicated [2, 5, 8]. In addition, it is not always possible to observe
the "tension-free" principle with the Lichtenstein technique. The encountered
weakness of the inguinal ligament makes us resort to grasping a part of the
aponeurosis of the external oblique abdominal muscle in a continuous suture for
a stronger fixation of the prosthesis. In addition, capturing the Cooper ligament
into the suture displaces the inguinal ligament downwards. As a result, suturing
of the flaps of the aponeurosis of the external oblique abdominal muscle is
impossible without tension. Even slight tissue edema occurring in the
postoperative period leads to even greater tension of the anterior wall of the
inguinal canal [1, 4]. In general, the described changes show that after
implantation of a synthetic prosthesis according to the Lichtenstein method in
the tissues of the inguinal region, there are processes that predispose to the
development of possible hernia recurrence.
The purpose of the study
is to optimize non-tension hernioplasty for
inguinal hernias by introducing a new method of alloplasty.
Materials and methods of research.
The study is based on the results of
examination and treatment of patients with inguinal hernias operated in the
surgical department of the multidisciplinary regional hospital of Bukhara in the
period from 2018 to 2023. Eighty-five inguinal hernia patients were selected for
prospective dynamic active study. They were male patients with different types
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of inguinal hernias. The patients were operated both in planned and emergency
procedures, and depending on the choice of treatment tactics the patients were
divided into two groups. The first group, the comparison group, consisted of 24
(28.2%) patients with inguinal hernias who underwent hernioalloplasty
according to the Lichtenstein method. The second, the main group consisted of
61 (71,8%) patients who underwent inguinal hernioalloplasty according to our
modified method. The results of surgical treatment of 24 patients of the
comparison group who were operated according to the I.L.Lichtenstein method
were analyzed. In the early postoperative period seroma of the postoperative
wound occurred in 4 (16.7%) patients, which was eliminated by puncture
method. Acute urinary retention was observed in 1 (4.2%) patient. 9 (37,5%) of
the patients operated according to the I.L.Lichtenstein method at the moment of
discharge indicated the feeling of a foreign div in the inguinal region, of which
inguinal neuralgia occurred in 3 (33,3%) patients. In 12 months after the
operation we managed to examine 23 (93,5%) (out of 24 patients in the
comparison group) operated patients, in 1 (4,3%) man after I.L.Lichtenstein
method surgery of elderly with benign prostatic hyperplasia, operated for hernia
with defect of 3 size and inguinal space more than 3 cm, recurrence of hernia
was revealed. Taking into account all the above-mentioned disadvantages and
possible complications in the postoperative period, we have developed and
introduced into practice a modified inguinal hernioalloplasty.
Results of the study.
Reducing the traumatic nature of surgical access
with early activation of the operated patients, the possibility of strengthening
the posterior wall of the inguinal canal with polypropylene mesh with
preperitoneal fixation contributed to a twofold reduction in the duration of
postoperative fever, i.e. seroma isolation decreased from 16.7% to 1.6%. After
alloplasty, changes in the inguinal canal were studied by ultrasound. In the
process of the study, in order to study the constituent tissues of the inguinal
canal, the thickness of the rectus abdominis, internal oblique and transverse
abdominal muscles, the height of the inguinal space at rest and under tension
(leg elevation at 15°) were measured in patients who underwent alloplasty of
the hernia defect 1 month after surgery in 47 (77.0%) and 19 (79.2%) patients
of the main group and in the comparison group, respectively. After alloplasty (in
1 month) during ultrasonography of the inguinal area the mesh implant behind
the seminal canal is well traced regardless of whether the plastic surgery was
performed according to the I.L.Lichtenstein technique or preperitoneal
alloplasty in the modification proposed by us. The transverse fascia cannot
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always be visualized. Under tension, regardless of the type of alloplasty, there
was a significant (p>0.05) increase in the thickness of the rectus abdominis
muscle, internal oblique and transverse abdominal muscles, and the thickness of
the inguinal canal. The height of the inguinal space slightly decreased (p>0.05).
This indicates that the changes in the inguinal region in patients after alloplasty
(according to I.L.Lichtenstein technique or preperitoneal hernia defect alloplasty
in the proposed modification) at rest and during loading are identical. Thus,
during straining the thickness of the inguinal canal reliably increases, and this
indicates that the mentioned operations do not disturb the comfortable
mechanism of the inguinal canal for the spermatic cord, which prevents a
possible disturbance of blood flow in the spermatic cord and testis.
Conclusions:
The operation according to the I.L. Lichtenstein method.
Lichtenstein operation is technically simple and accessible in performance, but
gives hernia recurrence in 5.3% of patients. Preperitoneal alloplasty of the
hernia defect in our proposed modification is a reliable alternative to the
operation according to the I.L.Lichtenstein method in the treatment of patients
with medium and large inguinal hernia, recurrent inguinal hernia, which, if
performed correctly, does not give recurrences and has a low number of
complications characteristic for alloplasty, which do not depend on the type of
the applied mesh implant.
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