Novosti
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Year 2012 Vol. 20 No 6
GENERAL AND SPECIAL SURGERY
A.V. FEDOSEEV, S.Y. MURAVYEV, I.I. USPENSKIY
OPTIMIZATION OF HERNIOPLASTY CHOICE METHOD IN PATIENTS WITH INGUINAL HERNIA IN VIEW OF THE SPERMATIC CORD BLOOD FLOW
SBEE HPE “Ryazan State Medical University named after academician I.P. Pavlov”
The Russian Federation
Objectives. To improve treatment outcomes in patients with inguinal hernias by optimizing the choice of inguinal hernioplasty methods depending on the of blood flow in the spermatic cord.
Methods. The research was conducted in two groups of patients. The control group included 28 subjects who don’t have inguinal hernias. The main group numbered 62 patients with the inguinal hernias. Depending on the method of hernioplasty patients were divided into three groups. In the first group an open preperitoneal hernioplasty was performed, in the second – Lichtenstein hernioplasty? in the third – laparoscopic hernioplasty (TAPP). A color duplex scanning of the arteries and veins of the spermatic cord was performed using the ultrasonic scanner Toshiba Nemio 580 before the surgery and 30 days afterwards.
Results. Preoperative velocity parameters of the blood flow along the spermatic cord vessels in the main group were identical with the data of the control group. During the postoperative period 30 days ofterword, in the patients who underwent an open preperitoneal hernioplasty, better blood flow in the spermatic cord was registered and, consequently, a smaller residual deficit of blood flow – 8,06%. Slightly larger deficit, 9,69%, after surgery was recorded in the 3rd subgroup of patients who had undergone TAPP. After surgical treatment, resistance index decreased to the level of the control group in the patients of the 1st and 2nd subgroups. Subgroup II patients who had undergone Liechtenstein hernioplasty, had the highest residual blood flow deficit – 15,40%, and resistance index – 0,85.
Conclusions. Preperitoneal prosthesis using an open technique as well as TAPP method is optimal for the patients with hernias as after their use a registered residual blood deficit is lower if compared with Liechtenstein hernioplasty.
Preperitoneal positioning of the implant is preferable for patients of the reproductive age to save their fertility.
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390013, Rossiyskaya Federatsiya, g. Ryazan, ul. Dzerzhinskogo, d. 11, MUZ GKB BSMP, kafedra obschey khirurgii,
e-mail: hirurgiarzn@gmail.com,
Muravyev Sergey Yurevich
Fedoseev A.V., Doctor of medical sciences, professor, head of the general surgery chair of SBEE HPE “Ryazan State Medical University named after Academician I.I. Pavlov”
Muravyev S.Y. Candidate of medical sciences, assistant of the general surgery chair of SBEE HPE “Ryazan State Medical University named after Academician I.I. Pavlov”
Uspenskiy I.I.. Assistant of the general surgery chair of SBEE HPE “Ryazan State Medical University named after Academician I.I. Pavlov”
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