THEORETICAL ASPECTS IN THE FORMATION OF
PEDAGOGICAL SCIENCES
International scientific-online conference
94
MODIFIED METHOD OF INUGINAL CANAL PLASTIC SURGERY
USING A MESH IMPLANT
Nosirov M.M.
Satvoldiev R.I.
Andijan State Medical Institute
https://doi.org/10.5281/zenodo.14771731
Aim of the study.
Improving the results of surgical treatment of patients
with inguinal hernias by improving the tactical and technical aspects of
performing prosthetic plastic surgery.
Materials and methods.
The clinical part of the study is based on
improving the tactical and technical methods of Lichtenstein plastic surgery for
inguinal hernia (IH).
The study covered the evaluation of the results of PG plastic surgery in 102
patients. All patients were male. Two clinical groups were formed for
comparison. The main group included 43 patients with PG, who underwent
hernioplasty using the proposed technique for the period from 2023 to April
2024. The comparison group included 59 patients with PG, comparable in terms
of the main clinical criteria to patients in the main group, all of whom underwent
the Lichtenstein operation in 2021-2022. Traditional mesh prostheses (Esfil,
Prolene) were used for PG plastic surgery in both groups. In both groups, more
than 60% of men were over 50 years old.
Results of the study.
The patients of the main group underwent an
improved method of Lichtenstein's operation, which in the method of alloplasty
of inguinal hernias provides the following distinctive features:
after opening the hernial sac and reducing the hernial contents into the
abdominal cavity, the hernial orifice is sutured from the inside of the hernial sac
with a purse-string suture while preserving the walls of the hernial sac, which
"wrap" the spermatic cord, after forming an opening in the mesh prosthesis
(MP) through which the spermatic cord passes, wrapped in the walls of the
preserved hernial sac, the said opening in the MP is sutured with a nodal suture
of 3/0 prolene thread, after which the free part of the peritoneum of the hernial
sac is cut off at a distance of 1.0-1.5 cm from the said opening, and the remaining
part of the peritoneum around the spermatic cord is fixed along the perimeter to
the opening in the MP in the form of a cuff, after fixing the MP at standard points,
the spermatic cord is placed on top of it, before suturing the sheets of the
external oblique abdominal muscle with the formation of an external opening of
the inguinal canal for the spermatic cord cord and layer-by-layer suturing of the
THEORETICAL ASPECTS IN THE FORMATION OF
PEDAGOGICAL SCIENCES
International scientific-online conference
95
wound. Before suturing the layers of the external oblique abdominal muscle to
form an external opening of the inguinal canal for the spermatic cord and layer-
by-layer suturing of the wound, the entire wound area was irradiated with a
Matrix 2k laser in the 337 nm range in scanning mode for 2-3 minutes at a
power of 2 mW with a spot diameter of 3-5 mm.
Fluid accumulation in the periprosthetic space is considered a frequent
complication after alloplasty. The frequency of detection of seromas using
objective research methods (ultrasound, CT) reaches 100%. In most cases,
seromas resolve on their own, but sometimes they require repeated punctures,
become infected and can cause an increase in the hospitalization period. The
maximum volume of serous fluid is usually recorded on the 3rd-5th day after
surgery with a further decrease by the 7th-10th day. Almost all patients became
active on the 1st-2nd day. The postoperative period in the patients operated by
us was uneventful. The patients in the department received appropriate
antibacterial therapy. Wound healing by primary intention. Postoperative
physiotherapeutic complex of anti-adhesive measures was carried out for all
patients, the complex included: early activation (within 24 hours after the
intervention), irradiation with Sogdiana laser with a wavelength of 998 nm,
frequency of 80 Hz, power of 7 W in pulse mode, duration of 3 minutes daily for
3-7 days. Patients in satisfactory condition were discharged on the 3-4th day.
Conclusions.
Thus, the developed method of alloplasty for inguinal hernias,
which provides for the isolation of the contact of the spermatic cord with the
mesh prosthesis to prevent the formation of local cicatricial adhesions and
maintain the mobility of the cord, as well as the use of laser exposure in the
ultraviolet spectrum during plastic surgery and in the infrared spectrum in the
early postoperative period, providing increased processes of resorption of
wound infiltrate, anti-inflammatory and wound-healing activity.
