Novosti
Khirurgii

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Year 2013 Vol. 21 No 4

GENERAL AND SPECIAL SURGERY

V.I. BELOKONEV 1,2, A.B. NASIBYAN 1,3, J.V. PONOMAREVA1

OPTIONS OF OPERATIONS IN PATIENTS WITH RECCURENT INGUINAL HERNIA AFTER PROSTHETIC HERNIOPLASTY

SBEE HPE “Samara State Medical University” 1,
MMBE “City Clinical Hospital ¹1 named after N.I. Pirogov” 2, Samara
SBME ND “Kinel central city and regional hospital” 3,
The Russian Federation

Objective. To improve the treatment results of patients with inguinal hernia recurrence after prosthetic hernioplasty through the development of operation methods, allowing to minimize damage to the elements of the inguinal canal and close the defect in the zone of the inguinal canal with a view of destroyed tissue elements in it.
Methods. The analysis of the treatment of 24 patients with recurrent inguinal hernia by Lichtenstein hernioplasty (with synthetic materials application) – in 16 (66,7%), the combined method – in 3 (12,5%), laparoscopic hernioplasty – in 5 (20,8%) has been conducted. In re-plasty a combined method (modification of Lichtenstein hernioplasty) is used with the new developed technique of operation combined with the methods of restoration of the destroyed inguinal ligament partially or completely in which the allocation of the hernial sac, the closing of the newly formed hernial gate have been conducted with the exception of direct contact with spermatic cord.
Results. During performance of repeated operations it was found that after prosthetic hernioplasty, recurrences can be caused by displacement of the prosthesis along the upper and lower contours without and combined with the destruction of the inguinal ligament. To prevent the complications of repeated operations in patients with the recurrent inguinal hernia the separation of prosthesis from spermatic cord technically should be excluded that achieved by localization of the access above the zone of incision of aponeurosis made during the previous operation. Out of 9 patients operated by a combined method, the complications occurred in 4 patients, only 1 case out of 15 underwent a new method of the operation. Intraoperative orchiectomy not connected with the spermatic cord damage was required in 1 case. Hernia recurrences were not noted in the observed period (1-5 years).
Conclusions. The use of a new method of the operation in which the intervention carried out outside of the contact zone of spermatic cord with a synthetic graft confirmed the effectiveness of this approach.

Keywords: prosthetic hernioplasty, recurrent inguinal hernia, options of operations
p. 33 – 39 of the original issue
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Address for correspondence:
443099, Rossiiskaia Federatsiia, g. Samara, ul. Chapaevskaia, d. 89, GBOU VPO «Samarskii gosudarstvennyi meditsinskii universitet», kafedra khirurgicheskikh boleznei ¹2,
e-mail: nbelokoneva@yandex.ru,
Belokonev Vladimir Ivanovich
Information about the authors:
Belokonev V.I. Honored physician of Russian Federation, MD, professor, a head of the surgical diseases chair ¹2 of SBEE HPE “Samara State Medical University”.
Nasibyan A.B. A surgeon of SBME ND “Kinel central city and regional hospital”, extramural post-graduate student of the surgical diseases chair ¹2 of SBEE HPE “Samara State Medical University”.
Ponomareva J.V. PhD, a senior researcher of the Institute of experimental medicine and biotechnologies of SBEE HPE “Samara State Medical University”.
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