COMBINED PLASTIC SURGERY OF THE POSTERIOR WALL OF INGUINAL CANAL WITH A MESH IMPLANT AND APONEUROSIS OF THE EXTERNAL OBLIQUE ABDOMINAL MUSCLE

Topicality: One of the negative sides of the inguinal canal plastics with a mesh implant is cicatricial changes in the structures of the spermatic cord in the place of its junction with the mesh. Purpose. Improvement of non-tension plastics of the posterior wall of the inguinal canal in patients with inguinal hernias. Material and methods. A technique of inguinal hernia repair with a combined plasty of the posterior wall of the inguinal canal with a polypropylene mesh and aponeurosis of the external oblique abdominal muscle was elaborated. The mesh implant is fixed on the posterior wall of the inguinal canal. From the upper flap of the aponeurosis its strip is cut out on two legs. After its fixation to the inguinal ligament, the internal oblique and transverse abdominal muscles,an aponeurotic posterior wall of the inguinal canal is formed. Results. In the elaborated operation of the inguinal hernia, the posterior wall of the inguinal canal is strengthened not only by the mesh implant, but also by the aponeurosis of the external oblique abdominal muscle. At the same time, the spermatic cord lies on the aponeurosis and not on the mesh, which is physiological and prevents the development of fibrous processes in the elements of the spermatic cord. All patients were discharged from the hospital on the 6th day in a satisfactory condition. Conclusions. The results of the elaborated operation for inguinal hernia indicate the absence of clinically significant complications in the early postoperative period. The proposed operation enables to avoid the negative effects of the mesh on the spermatic cord due to the inclusion of the latter in the “aponeurotic tunnel”.