Lichtenstein Plastic for Inguinal Hernia

Abstract

Relevance. The issues of surgical treatment of inguinal hernias have not been unambiguously resolved to date. Surgeons have proposed a large number of methods of surgical interventions, however, the ideal intervention has not yet been developed. The problem is urgent and needs further development and study.Material and methods. The results of treatment of 250 patients with inguinal hernias were analyzed. All operated on are men. The patients' age is from 25 to 86 years. According to the classification of Leoyd M. Nyhus (1995): direct hernias (type IIIa) were present in 111 (44.4%) patients; large oblique hernias (type IIIb) -in 74 (29.6%); recurrent hernias (type IV) were diagnosed in 65 (26%) patients. During the examination, 163 (%) patients had various comorbidities: hypertension 72 (44.2%), coronary heart disease 33 (20.2%), diabetes mellitus 21 (12.9%), bronchial asthma, pulmonary emphysema, pneumosclerosis 18 (11%), varicose veins of the lower extremities 12 (7.4%), previous CVA 7 (4.3%). Of 74 patients with recurrent and hernias, 23 had a second, 9 had a third relapse, Results. During the operation, local infiltrative anesthesia was used in 174 (69.6%) patients for anesthesia, epidural anesthesia was used in 60 (24%) cases, general anesthesia occurred in 16 (6.4%) patients. During the operation, we attach particular importance to minimal tissue trauma and hemostasis. Postoperative complications: in 26 (10.4%) cases, there was a slight scrotal edema, which completely disappeared within 1014 days after the operation. The occurrence of this complication is associated with compression of the spermatic cord into the hole created in the mesh implant; in 13 (5.2%) patients who were operated on for recurrent hernias, in the postoperative period and during the control examinations, there were areas of sensitivity disturbance in the operation area, which we associate with trauma to the nerve trunks during dissection of scar tissue. Conservative treatment after surgery included antibiotic therapy, pain relief, prevention of thromboembolic complications. There were no lethal outcomes. Long-term results by telephone survey were studied in the period up to 5 years after surgery, in 102 (40.8%) patients, recurrent hernias were not observed. The patients are feeling well.Findings. Thus, hernia repair according to the Liechtenstein technique using a polypropylene mesh is the operation of choice in patients with straight (type IIIa), large oblique (type IIIb), recurrent hernias (type IV). Strict adherence to the operating March 19, 2021 • Cambridge, UK • 179 .technique, high-quality hemostasis, full-fledged conservative therapy allows avoiding the development of complications at various stages of treatment.