The results of laparoscopic without fixing аllohernioplasty in the treatment of inguinal hernias

• Zaitsev O.V.
• Anna V. Koshkina
• Yudin V.A.
• Barsukov V.V.
• Bragina I.Yu.

Abstract

Background. The relevance of this study is confirmed by the unsolved number of issues related to the results of treatment of inguinal hernias. Despite the best experience in the treatment of inguinal hernias, there are postoperative complications such as pain and relapses. With the development of laparoscopic treatment, the percentage of the above-mentioned complications has significantly decreased. But there are still questions: whether it is necessary to fix the mesh endoprosthesis, what material should preferably be the mesh endoprosthesis, the optimal size of the mesh endoprosthesis.

The aim is to improve the results of surgical treatment for patients with inguinal hernias by using a rational method of placement and fixation of the polyproplastic endoprosthesis during laparoscopic hernioplasty.

Material and methods. The work was performed based on the results of surgical treatment of patients with inguinal hernias from 2015 to 2020. Patients entered the study based on inclusion, non-inclusion, and exclusion criteria. In total, the study included 207 patients. The patients were randomly divided into the main and control groups. The main group included 102 patients. All patients in this group underwent laparoscopic hernioplasty of inguinal hernias without fixing the mesh polypropylene endoprosthesis with a herniastepler. The control group included 105 patients who underwent laparoscopic hernioplasty of inguinal hernias with a mesh endoprosthesis with fixation of the latter using a Protack 5.0 herniostepler with titanium spiral clips. To assess the immediate results of treatment in the comparison groups we assessed the following criteria: duration of surgery, the severity of postoperative pain by Visual Analogue Scale (VAS), frequency and severity of post-operative complications, estimated on a scale of Clavien-Dindo, the dose of the analgesics (opioid derivates), the average length of hospitalization and the presence or absence of early recurrence of inguinal hernia estimated by the moose thumb assessment of the superficial inguinal ring, "cough push" symptom and ultrasound examination of the inguinal region.

Results. The duration of surgery, postoperative complications, the average length of hospitalization, and the postoperative period for relapses did not differ significantly in both study groups. The level of postoperative pain, estimated by VAS and the dose of the prescribed narcotic analgesic, is significantly lower in the main group.

Conclusion. The developed technique of performing laparoscopic inguinal hernioplasty without fixing the endoprosthesis with a hernioplayer can improve the quality of life of patients in the immediate postoperative period: the pain syndrome is significantly lower, there are no relapses.

Keywords:inguinal hernia, laparoscopic hernia repair, hernias stapler

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