Laparoscopic hernioplasty: the technology of future
Abstract"Unstretched" techniques of the anterior abdominal wall correction using synthetic prosthesis are currently the undisputed favorites in the treatment of inguinal hernias. Surgical interventions with the use of the mesh are main ly represented by the following methods: 1) Lichtenstein tension-free mesh inguinal hernia repair (used in the original technique, practically without modification); 2) laparoscopic hernia repair (various options); 3) open surgery using synthetic hernia systems (PHS, UHS, Trabucco et al.). Laparoscopic hernia repair includes several methods: 1) intracorporeal suturing of the internal inguinal ring (Nyhus type); 2) total extraperitoneal hernia repair (TEP); 3) laparoscopic transperitoneal inguinal hernia repair (TAPP). The authors prefer the TAPP approach.
Material and methods. The authors’ clinical experience is more than 2500 surgeries for all types of inguinal hernias. Duration of the operations ranged from 20 to 90 minutes, 25-45 minutes on average. Hospital length stay ranged from 1 to 4 days, in the vast majority of cases not exceeding 2 days.
Results. The authors did not observe severe intraoperative or postoperative complications as well as conversion to open surgery upon failure of laparoscopic access. Total number of less significant complications was observed in 2.3% of patients, with the majority of them in the first 800 operations using heavy meshes. Recurrence of the disease was observed in 9 patients, which amounted to 0.36%. The causes of recurrence: the use of the uncut or heavy mesh, inadequate fixation of the mesh, the small size of mesh implants, prosthetic mesh deformation. All patients with recurrent hernias were operated again, in 6 cases we performed laparoscopic hernia repair using larger sized prosthesis, in 3 cases the Lichtenstein technique was used.
Conclusion. Thus, laparoscopic treatment of hernia (TAPP) is pathogenetically substantiated, provides good access and visualization of anatomical structures, allows surgeons to perform hernia repair with minimal trauma and maximum reliability.
Keywords:hernioplasty, laparoscopy, new technologies
Clin. Experiment. Surg. Petrovsky J. – 2014. – N 3. – P. 62–69.