HERNIOTOMY IN OUTPATIENT PRACTICE

V.J. GORBUNKOV, I.E. VARTANOV, A.V. DYADKOV,

O.V. NAZARENKO, A.G. KATASONOV

Stavropol State Medical Academy, Stavropol, RUSSIA

The urgency of this problem is caused by a large number of patients and unsatisfactory results of surgical treatment of external abdominal hernia. Despite the development and introduction of new methods of hernioplasty, the recurrence rate of this disease ranges from 5 to 35%. We studied 169 case histories of patients with external abdominal hernia, operated in the Ambulatory Surgery Center of Stavropol in the last 5 years. 125 [74,0%] patients were with inguinal hernias. 79 [63,2%] of them were with oblique hernias and 46 [36,8%] - with direct hernias, one of which was combined with hydrocele and two patients with recurrent hernias were. The remaining hernias: umbilical - 35 [20,7%], lineae albae - 6 [3,6%] and femoral - 3 [1,8%]. The age of patients was 24 to 72, among them: men -118 [69,8%], women - 51 [30,2%]. In the group of the working age population included 115 [68,0%] patients. On the first visit to the Ambulatory Surgery Center surgeon assesses the general condition of the patient, location of hernia, appoints clinical - laboratory tests and recommends the consultation of related professionals: general practitioner, gynecologist, an anesthesiologist and the physician-urologist.

The main form of anesthesia - local infiltration anesthesia with 0,5% lidocaini and spinal anesthesia with 0,5% solution markaini 3-4ml. at L3-4. When choosing a method of herniotomy we follow the principle of individual approach. 52 [30,8%] of 169 patients operated on traditional autoplastic ways. Hernioplasty with polypropylene mesh prosthesis - 117 [69,2%] patients, of whom 95 [82,0%] operated by the method of Lichtenstein. Number of complications after herniotomy with autotransplantation local tissues was observed in 4 [7,7%] patients, and after hernioplasty with alloplastica - was detected in 2 [1,7%] patients. All complications in these patients were treated conservatively. So the last 2 years, we prefer the latest technology hernioplasty as the most optimal and reliable in ambulatory surgery.

Conclusion: Our experience with surgical treatment of patients with external hernias in an Ambulatory Surgery Center of Stavropol allows us to identify a number of advantages in the treatment of hernias in ambulatory centers: reducing the timing of planned operations, especially on modern technology, free up beds in surgical hospitals for more complex surgical procedures, excluding the possibility in-hospital infection, achieving significant economic benefits.

Date: 2014-12-28; view: 835