Volume 03 Issue 02-2023
20
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
02
P
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:
20-25
SJIF
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FACTOR
(2021:
5.
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(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
ABSTRACT
The elimination of PG should be carried out mainly by laparoscopic method, since this GP method provides a low
percentage of relapse, complications, which allows to restore the QOL of patients in the shortest possible time and
increase the reproductive function of operated patients.
KEYWORDS
Hernioplasty, laparoscopic, patients' reproduction.
INTRODUCTION
According to statistics, hernia carriers are 3-4% of the
population, which is 530-570 million people on the
globe [1,3,5,7,9,11], of which 6-7% are men with inguinal
hernias, 2.5% are women. In almost 80% of patients,
hernia has inguinal localization [2,4,6,8]. More than 2
million operations are performed annually in the world
for abdominal hernias [10,12,14,16]. Hernia section (HS)
for inguinal hernias occupies the 3rd place in frequency
among planned and emergency interventions, which is
24-66% of all operations of general surgical profile
[13,15,17].
The introduction of new progressive technologies into
clinical practice in recent years has made it possible to
achieve some success in the treatment of inguinal
hernias. However, despite the successes achieved and
a large number of existing techniques (more than 600
methods), the results obtained are not always
satisfactory. Currently, the requirements of patients
Research Article
THE EFFECT OF VARIOUS METHODS OF HERNIOPLASTY ON THE
FERTILITY OF PATIENTS
Submission Date:
February 11, 2023,
Accepted Date:
February 16, 2023,
Published Date:
February 21, 2023
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume03Issue02-05
Khamdamov I. B.
Bukhara State Medical Institute Named After Abu Ali Ibn Sina. Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 03 Issue 02-2023
21
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
02
P
AGES
:
20-25
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
for the quality of life (QOL) have increased many times,
taking into account its physical and emotional and
mental components [18]. Dissatisfaction of patients
with QL pushes surgeons to search for new technical
and tactical solutions in hernioplasty (GP). Like any
surgical intervention, inguinal GP is associated with the
possibility of non-specific (formation of hematomas
and seromas, suppuration of postoperative wounds,
formation of ligature fistulas) and specific (damage to
the bladder, femoral vessels, dropsy of the testicular
membranes, inguinal-genital neuralgia, recurrence of
hernia) complications, which account for 1-30% [1,2].
Specific complications of inguinal hernia section
include deterioration of reproductive function in men.
The purpose of the study. To improve the results of
surgical treatment of patients with inguinal hernias
based on the study of patients' reproduction.
Materials and methods of research. The study was
based on the analysis of the results of surgical
treatment of PG in 448 patients hospitalized and
operated in the basic surgery departments of the
regional hospital of the Department of Faculty and
Hospital Surgery, Urology (head of the department -
professor B.Z.Hamdamov) for the period from 2017 to
2021.
Criteria for inclusion of patients in the study: -
Voluntary consent to surgical treatment of PG; -
planning of surgical intervention for PG; 640 patients
hospitalized during the specified period of time met
these criteria.
Criteria for excluding patients from the study:
-
the
presence
of
relative
and
absolute
contraindications to any type of hernioplasty
provided for by this study (13 patients);
-
a history of surgery for varicocele or dropsy of
testicular membranes (6 patients);
-
detection of a history of spermatogenesis
disorders before the development of a hernia (1
patient);
-
cryptorchidism (1 patient);
-
refusal of the patient to participate at any stage of
the study (lack of informed consent to participate
in a scientific study) (124 patients);
-
the age of the patient is less than 18 years and more
than 76 years (47 patients)
The following scope of research was mandatory for the
planned operation: clinical and biochemical blood
tests, general urine analysis, electrocardiography,
chest fluorography, markers for hepatitis B and C,
coagulogram, ejaculate volume, sperm concentration
and the number of mobile forms, determination of the
function of external respiration, reserve capabilities of
the cardiovascular system, X-ray and ultrasound
studies of abdominal organs (ultrasound scanners
were used: Aloka Prosound 6, GE Vivid S5, GE Logic.),
fibroesophagagogastroduodenoscopy. Other research
methods were performed according to indications.
We did not use the principle of randomization in the
distribution of patients into comparison groups, since
the preferences of patients were taken into account
when choosing the GP method. Nevertheless, the
analysis of the structure of patients in all three groups
allows us to consider the groups relatively
homogeneous (comparable to each other) and
generally representative. The study of the quantitative
and qualitative composition of the ejaculate was
carried out by the classical method, the gold standard
in the diagnosis of "men's health", which reflects the
state of spermatogenesis
–
spermography.
The results of the study were subjected to statistical
analysis using the Statistica-6.0 application software
Volume 03 Issue 02-2023
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(ISSN
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VOLUME
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893
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(2023:
6.
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OCLC
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1121105677
Publisher:
Oscar Publishing Services
Servi
package from StatSoft, Inc 1984-2001. When
conducting statistical processing, all the requirements
of the concept of evidence-based medicine are taken
into account. The quantitative data obtained in the
course of the study were preliminarily evaluated for
the type of distribution using the Kolmogorov-Smirnov
agreement criterion. Parametric data are presented in
the form M±a, where M is the arithmetic mean and ct
is the standard deviation. in patients with unilateral
hernias, right-sided Pg was mainly observed (x2=5.8,
p=0.02). Thus, unilateral hernias were observed in 398
(88.8%) patients: left-sided - in 189 (47.5%) patients,
right-sided - 209 (52.5%). Bilateral hernias were
observed in 50 patients, only in men and mainly in the
older age group and accounted for 11.5% of the total
number of hernias. Oblique PG was observed in 351
(78.3%) patients, straight - in 97 (21.7%). The duration of
the postoperative period in the hospital after
musculoaponeurotic GP was 8.7±2.23 days, after
Lichtenstein surgery - 8.0±2.19 days (p=0.0026), after
LH - 4.3±1.5 days (p<0.0001). Due to the small number
of complications, it is not necessary to talk about the
reliable advantages of one or another GP method. The
absence of a statistically significant difference in the
frequency of complications of the immediate
postoperative period, in our opinion, is due to the low
statistical power. However, the trend towards a
decrease in the frequency of complications in LH is
emerging. The immediate results of surgical treatment
of PG are as follows: total complications in 30 patients
(6.7%). Of these, 13 (11.2%) patients of group I, 16
patients (5.5%) of group II and 1 patient (2.2%) of group
W. Relapses were detected in 10 patients (2,2%): 6(5,2%)
after muscular-aponeurotic plastic surgery, 4 (1.4%)
after non-tensioning plastic surgery. There were no
relapses after endoscopic hernioplasty. In types I-II of
hernias, good results were obtained both with
traditional muscular-aponeurotic GP and with a non-
stretching technique. However, with the type of
hernia, the recurrence rate is significantly higher with
muscular-aponeurotic GP and is 3.4%. It should be
noted that mainly relapses in groups I and II were
observed in patients operated on for bilateral hernias -
4 patients (3.3%) and 3 patients (1.0%), respectively.
Since the characteristics of the comparison groups as a
whole did not have fundamental differences among
themselves, the initial results of the QOL survey of
patients turned out to be quite low. The average
indicators on the total scales of physical (PHs) and
mental (MHs) components of health were reduced by
about two times compared to the proper: 51.0% and
39.7%, respectively. Low indicators characterizing
various aspects of the physical and mental functioning
of the patient, in general, indicate a low self-esteem of
QOL in the studied group of patients. Undoubtedly,
low QL on all scales is a consequence not only of the
presence of PG in the patient. Most of the patients,
especially the older age group, had a number of
concomitant chronic diseases that limited physical and
mental activity. As demonstrated by the data obtained
during the correlation analysis, the indicators on
individual scales have a statistically significant and
significant association with the age of the patient. In
particular, the greatest degree of association with age
was revealed on the scale of physical health (g8 =-0.43;
p = 0.00). Noteworthy was the degree of association of
the patient's age and the indicator of role functioning
due to the physical condition of the patient (CR) (gz =-
0.09; p=0.054). A slightly less strong inverse
association with age is observed on the scales of
mental health (MP) (g8=-0.2; p=0.00002), vital activity
(UT) (g5=-0.13; p=0.007) and the physical component
of health in general (RNz) (G5=-0.14; P=0.003).
According to the other scales, a reliable degree of
association of indicators with the age of the patient
was not revealed. The results of the QOL assessment in
dynamics 4 months after Gp are as follows. Changes in
Volume 03 Issue 02-2023
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VOLUME
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Publisher:
Oscar Publishing Services
Servi
values on the QL scales in all patients 4 months after
Gp were observed in 29.7-40.4% of cases. The ratio of
patients with positive and negative dynamics of
indicators according to the SC scales in the first group
shows predominantly negative dynamics. The worst
changes in this group were noted on the scale of role
functioning due to physical health (CR) - 28.9%, the
total indicator of the physical component of health
(RNz) 27.7%, the total component of mental health
(MNh) 34.0%.
Compared with this group, in group II of patients, and
in the group of patients who received LH, cases with
positive dynamics exceed the number of cases with
negative dynamics. This is indicated by the total
indicators of physical and mental functioning (RNz,
MNz), respectively, 42.2% and 67.2%. A comparatively
more pronounced positive dynamics of QOL in the 4
months after GP was noted in patients of the third
group, where cases with positive dynamics ranged
from 61.1% (RNz scale) to 83.3% (MNz, UT, OH, PP
scales) of cases. In general, the indicators of physical
and psychoemotional functioning in patients with PG
are reduced to 39.7-75% of the proper. In other cases,
the dynamics were not noted, which indicates the
previous self-assessment of their own abilities for
physical activity and the preservation of the psycho-
emotional status in most patients in the first months
after surgery. A relatively large number of patients
who have a decrease in QOL indicators 4 months after
surgery is due to the absence of any pain
manifestations from the hernia before surgery in most
cases. The weak dynamics of indicators (on average by
0.7-5% on different scales) generally indicates a low
contribution of PG as a pathology that has a negative
impact on QOL in the patients included in the study.
After Liechtenstein Gp, negative changes in sperm
concentration and motility are significantly less
pronounced than after traditional Gp. The average
concentration of spermatozoa per unit volume of
ejaculate after surgery decreases by 7.8 ± 10.9 million /
ml, which is approximately 9% of the baseline.
Moreover, by the end of 12 months after Lichtenstein
surgery, the concentration of spermatozoa decreases
even more - on average by 15.3 ± 20.9 million/ ml (p =
0.00), which is approximately 17% of the initial value.
The relative number of mobile forms also decreases by
6.6%. Probably, the continued decrease in sperm
concentration is negatively affected by the
endoprosthesis, which "accompanies" the vas
deferens for a longer period. The decrease in sperm
motility according to the data for 4 and 12 months after
the Liechtenstein Gp is not so pronounced, although
statistically significant (p <0.001).
After LH, no negative dynamics was observed both in
terms of sperm concentration and in terms of their
mobility. On the contrary, according to the mobility
index, by the end of 12 months after surgery, there is a
slight increase in the relative number of motile
spermatozoa. To assess the degree of influence of
operational equipment on the reduction of the level of
Tc, we analyzed the indicator in various groups before
and after surgery. Initially, the Tc level was reduced in
all three groups, thus, the groups turned out to be
homogeneous in this indicator. This makes it possible
to interpret subsequent changes as changes due to the
peculiarities of the Hs method and Hernia gate plastic
surgery. In general, without taking into account the
peculiarities of PC plastic surgery in various variants of
surgery, the dynamics of spermogram indicators after
surgery turned out to be negative. After 4 months, the
Tc level was 2.5± 2.4 nmol/l lower than the initial one.
The above confirms that carrying out GP by a stretch
method has a negative effect on the reproductive
function of male patients. Performing LH practically
does not worsen the studied indicators, which should
Volume 03 Issue 02-2023
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(ISSN
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VOLUME
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OCLC
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Publisher:
Oscar Publishing Services
Servi
be taken into account when determining indications
for various methods of surgical treatment of PG in
men.
CONCLUSIONS
1.
A comparative analysis of the traditional criteria for
the results of hernioplasty revealed the superiority
of
non-stretching
methods
over
muscle-
aponeurotic methods. Recurrence rates for 1-2
types of inguinal hernias after various Gp methods
do not significantly differ, but with 3-4 types of
hernias after musculoaponeurotic plastic surgery,
the recurrence rate is 7.0% (DIrh: 0.00%- 13.7%)
higher than with non-protracted Gp methods. The
probability of a relapse-free course after muscular-
aponeurotic plastic surgery decreases in the long-
term postoperative period earlier and at a faster
rate than after Lichtenstein and LH surgery.
2.
Indicators of physical and psychoemotional health
in patients with PG decreased from 39.7% to 75% of
the required. The elderly age of patients negatively
affects the quality of life after GP with inguinal
hernias. By the year after GP, QOL indicators,
regardless of the method of surgery, significantly
improved
in
31.7-64.3%
of
patients.
The
improvement of QL indicators after LH in
comparison with other methods occurs much
faster, and reach maximum values by the end of 4
months after surgery.
3.
Muscular-aponeurotic Gp of the inguinal canal is
fraught with a large number of complications,
relapses, which reduces the quality of life. In this
connection, it is necessary to selectively carry out
these hernioplasty techniques depending on the
age of the patient and the type of hernias, that is,
this plastic surgery is indicated for men of
reproductive age and women with 1-11 types of
hernias.
4.
The elimination of PG should be carried out mainly
by laparoscopic method, since this Gp method
provides
a
low
percentage
of
relapse,
complications, which allows to restore the QOL of
patients in the shortest possible time and increase
the reproductive function of operated patients.
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