VARIANT OF INGUINAL CANAL PLASTY IN HERNIAS IN GERIATRIC PATIENTS
R.T. MAJIDOV, V.V. KHSEYKHANOVA, K.M.KURBANOV, U.A. NASIBOVA
Veterans Hospital, Makhachkala, RUSSIA
Urgency. The method of plasty of inguinal hernias using polypropylene mesh by Lichtenstein is a most common methods differing by several positive features (easiness, the possibility of an early activation of patients, a significant reduction of pain syndrome in the postoperative period, a rapid improvement in quality of life, etc.).
The aim of the study. To study the effectiveness of “non-tightened” methods of inguinal canal plasty in hernias in patients of elderly and old age.
Materials and methods. Our clinic uses a slightly modified version of the operation of Liechtenstein. The basic principles of hernioplasty operation are:
- Traditional front inguinal access to hernial sac
- Insertion of a purse-string suture of the neck of the hernial sac in all cases of inguinal hernias, except for shifting
- Recovery of all layers of the spermatic cord in oblique inguinal hernias
- Plasty of the back wall of the inguinal canal with polypropylene mesh in recurrent hernias - PHS of «Ethicon» company
- Restoration of the inguinal canal by suturing leafs of abdominal external oblique muscle aponeurosis, dissected at the opening of the inguinal canal.
In 100 observations there was performed plasty of the inguinal canal by using polypropylene mesh SPMM of «Auto Suture» Company and PHS of «Ethicon» company by Liechtenstein y of the back wall of the inguinal hernia in patients of elderly and old age, and 100 patients – plasty of the back wall of the inguinal canal was performed in the modification of the clinic. All patients were persons aged over 70 years. Oblique inguinal hernia occurred in 100 patients (43.4%), direct - in 148 (56.6%). In 30 (15.0%) patients the process was bilateral. Recurrent inguinal hernia was in 22 (11.0%) patients. In 248 (82.7%) patients had comorbidities.
Results and discussion. The average duration of hospital treatment in the main group of patients constituted 8,1 ± 1,6 bed-days, given the age of patients the presence of comorbidities in the majority of patients, in the control group - 9,2 ± 1,2 bed-days. Activation terms of patients were minimal and constituted: 1,6 ± 0,3 bed-days in the main, 1,9 ± 0,4 bed-days in the control group. The absence of thromboembolic complications in these patients is likely connected with it. The main positive point is the absence of graft migration in our patients with the modification of cases of hernioplasty, which is in many cases associated with the method of fixation of the prosthesis. In the control group, this complication occurred in 3 (3.0%) patients. The proposed method combines high efficiency in terms of recurrence of the disease (0%), and allows to carry out early activation of patients that is important for performing the operation in patients of elderly and old age with concomitant diseases.
Thus, “non-tightened” methods of hernioplasty by using polypropylene mesh are the most promising of the herniology and this explains hteir so wide clinical application. Sound fixing of the polypropylene mesh in the inguinal space provides a high effectiveness of the method.
Date: 2014-12-28; view: 428