SURGICAL EVOLUTION OF INGUINAL HERNIAS

A high percentage of relapses forced the surgeons look for more reliable ways to strengthen the anterior and posterior walls of inguinal hernias. We have developed some original modifications; one of them is as follows: after fixing the mesh to the inguinal ligament, we fix the medial part of the P-like nodal sutures to the aponeurotic-muscular flap. So, the mesh implant is tightened under the abdomen inner oblique muscle and prevents the stratification of the muscle by fixing the mesh together with aponeurosis of the outer oblique stomach muscle. The proposed method significantly reduces possibility of appearance the hernia relapses. This usually makes the operation long-lasting, but it may be necessary to sacrifice time in order to prevent the recurrence of hernia. The second weak point in the plastic of hernia is the inner ring of the inguinal canal, through which the spermatic cord comes out. As a rule, the stenosis achieved by stitching the posterior wall of the inguinal canal (weak and thin transverse fascia) and the legs of the mesenteric implant. Moreover, the final are fixed by several methods: the hole in the net is cut out, which is equal to the diameter of the spermatic cord. The mesh near the spermatic cord is dissected crosswise. The angles of the cut bend back and make a ring with 4 petals. Between two petals, the angle of the mesh with one nodal seam is fixed to the edge of the inner inguinal ring, and the top of the petal is just the same by one nodal seam to the spermatic cord. We hope that due to this technique we strengthen the inner ring of the inguinal canal and eliminate the interval between the final and the net. The age of the examined patients varied within the range of 22-86 years. In 134 patients the plastic of inguinal hernia was performed with their own tissues, mainly by Postemsky (84%) and Basini (13%). In 3% of cases, operations were performed by the Spasokukotsky method with Kimbarovsky seam. As the surgeons explained, the stretching method of plastic hernia by their own tissues were chosen in connection with the young age of patients (up to 30 years), and in 2 cases – due to severe concomitant pathology in the elderly people for the rapid elimination of the hernia defect. By the Liechtenstein method, 83.5% of patients were operated in the modification. The final is the methods described above for fixing the implant. Practically the classical method of Liechtenstein isn't used because of its shortcomings. The obligatory point of the operation was a thorough hemostasis. The operation was completed, as a rule, with the Redon type of drainage. The last one is kept during 2-4 days until it was active. Serous inflammation in the postoperative wound area was observed in 5% of patients: postoperative hematoma-1%, infiltrate-3% and orchitis-1%. All these complications have been eliminated by conservative measures. The patients began to walk on the first day after surgery. As a result of using of non-tense methods of surgery, the average l/day decreased from 6.2 to 4.3.