Introduction. The frequency of the inguinal hernia of the repeated recurrences is up from 9,3 to 12%. In surgical treatment re-fixation of the mesh to the atrophied tissues of the inguinal canal is unreliable. The posterior access can be much more reliable for the patients, in which the mesh will be fixed to the unchanged muscular-aponeurotic tissues of the inguinal area. Aim. To increase the efficiency of recurrent inguinal hernias surgical treatment by justification of using the TAPP surgical technology.

The aim. Improve results of the surgical treatment of recurrent inguinal hernias after Lichtenstein's surgery by using an advanced TAPP technique. Materials and methods. An analysis of the surgical treatment of patients with recurrent inguinal hernias after Lichtenstein's surgery using traditional and improved preperitoneal transabdominal alloplasty (TAPP), for the period of 2012–2019, was performed. The traditional TAPP technique was performed for 52 patients who made up the 1st group. An improved TAPP technique was implemented for 53 patients who composed the 2nd group. The features of the improved TAPP technique, which was different from the traditional one, were by additional mobilization of the parietal peritoneum by 3–4 cm along the upper edge of the defect, the mesh implant was used with a larger size in comparison to the classical one – 15×15 cm and fixed, besides the traditional points, additionally on the lower and lateral edges with medical glue Sulfacrylate. Results. The results of surgical treatment in the early postoperative period were not significantly different and were comparable. During the long-term period, 51 patients from the 1st group, and 50 patients from the 2nd group were examined. Thus, in the first group in 4 (7.9 %) cases during 6 months period after the application of the traditional TAРР technique, chronic pain was observed on the site of the implanted mesh; among the 2nd group of patients chronic inguinal pain was not observed. In 5 (9.8 %) patients of the 1st group, the recurrence of inguinal hernia was diagnosed, instead of the 2nd group, where relapse was observed in 1 (2 %) case. Conclusions. Thereby, the results of the traditional and improved TAPP techniques confirm the higher efficiency of the improved technique, due to the absence of the chronic inguinal pain and a lower rate of relapses, which is achieved by wider mobilization of the parietal peritoneum along the upper edge of the defect, and usage of the larger mesh and its additional fixation by gluing it at the lower lateral edge.

The aim — to improve the surgical treatment effectiveness for recurrent inguinal hernias after the Liechtenstein surgery by transabdominal preperitoneal alloplasty optimizing.Materials and methods. The surgical treatment results of 65 patients with transabdominal preperitoneal alloplasty for relapses after the Liechtenstein surgery in the Department of Surgery, for the period of 2012 — 2018 has been analysed. The patient’s age ranged from 19 to 74 years (mean age was 51.6 ± 1.2 years). All patients were men. Concomitant pathology was noted in 27 patients (41.5 %). Relapses after the Liechtenstein surgey has been developed after 3 months in 18 patients (27.7 %), after 6 months in 38 (58.4 %), after 12 months 9 (13.9 %). According to the Campanelli G. classification (2006) patients were devided into 3 groups: the first group (R1) included 18 (27.7 %), the second (R2) — 33 (50.7 %) and in the third (R3) ‑14 patients (21.5 %). Depending on the transabdominal preperitoneal alloplasty method, patients were divided into 2 groups. The first group 32 patients were operated by the classical transabdominal preperitoneal alloplasty, in the second are 33 patients was performed by improved transabdominal preperitoneal alloplasty. This method differed from the classical one by additional mobilization of the upper peritoneal flape upward by 3 — 4 cm. The mesh was introduced into the abdominal cavity by 3 — 4 cm wider (12 ´ 15 cm). The mesh was fixed by standard method, with an additional glue fixation on the lower edge.Results and discussion. In group I, in the early postoperative period, 3 (9.3 %) patients had serum cysts on the side of the operation, subcutaneous hematomas occurred in 4 (12.1 %). In the late postoperative period, 2 (6.2 %) patients experienced chronic inguinal pain. Recurrence was diagnosed in 3 (9.3 %). In group II, in patients undergoing advanced transabdominal preperitoneal alloplasty the serum cysts was in 4 (12.1 %) cases, subcutaneous hematomas were reported in 4 (12.1 %) patients. In the distant period, chronic inguinal pain was diagnosed in 1 (3.1 %) patient, no recurrence was observed.Conclusions. The use of advanced transabdominal preperitoneal alloplasty in the treatment of recurrent inguinal hernias after the Liechtenstein surgery, due to the wider coverage of the inguinal region with the mesh implant, has advantages over the classic transabdominal preperitoneal alloplasty and reduces the inguinal hernia recurrence rate from 9.3 % in the 1st group, to no relapse in the 2hd group

Мета роботи: покращення результатів лікування хворих із рецидивом пахвинних гриж після операції Ліхтенштейна. Матеріали і методи. Проведено аналіз хірургічного лікування 105 пацієнтів із рецидивною пахвинною грижею після операції Ліхтенштейна. Всі хворі були чоловіки. У 31 (29,5 %) хворого рецидив виник через 3 місяці після первинної пластики, після 6 міс. – у 59 (52,3 %), після 12 – у 19 (18 %), 26 хворих (24,7 %) мали супутню патологію. В першій групі 52 пацієнтам виконувалось класична ТАРР. Під загальним знеболенням накладали карбоксиперитонеум, встановлювали 3 троакари, основний етап ТАРР, розрізання парієтальної очеревини над пахвинними ямками, після чого преперитонеально встановлювали сітку 10×12 см, з наступною фіксацією її до зв’язки Купера і м’язів черевної стінки. В другій групі – 53 хворі – виконували удосконалену ТАРР. Суть удосконалення – додаткова мобілізація верхнього клаптя парієтальної очеревини краніально на 3-4 см, заводилась ширша сітка 15×15 см. Комбінована фіксація імплантату герніостеплером і клейова фіксація клеєм Сульфакрилат. Результати досліджень та їх обговорення. В першій групі, у 5 хворих (9,6 %), були сероми на стороні герніопластики. В більш пізньому періоді хворі спостерігались у строках 6, 24 та 36 місяців. Так, у 4 (7,7 %) було діагностовано хронічний пахвинний біль. Повторний рецидив спостерігали в 5 (9,6 %). В другій групі сероми – у 6 (11,3 %) хворих, у 3 (5,6 %) хворих діагностований хронічний пахвинний, повторний рецидив 1 (2 %). Використання удосконаленої ТАРР, порівняно з класичною методикою, при рецидивах пахвинної грижі після операції Ліхтенштейна, за рахунок використання більшого сітчастого імплантату 15×15 см та його клейова фіксація по нижньому краю сприяють зменшенню частоти повторного рецидиву з 9 до 2 %.