Postoperative outcomes in patients after modified inguinal reconstruction: An observational cohort study

Abstract

Background. Despite major progress in surgical care, the need remains to reduce the number of recurrences in the postoperative period in inguinal hernia patients and to improve their quality of life (QoL). To this end, the development of a technique for hernia repair, which would decrease dependence on the availability of consumables, appears promising. We present the surgical outcomes of inguinal hernia patients treated by the technique of tension-free hernioplasty using implants and auto-tissue flaps. Objective. To develop a technique for hernia repair with a reduced dependence on the availability of consumables, which could decrease the number of recurrences in the postoperative period in inguinal hernia patients and to improve their QoL indicators. Methods. An observational cohort study of 759 patients with inguinal hernias aged 18 years and older was conducted. The patients underwent treatment at the Ryazan City Clinical Hospital No. 11 and the Ryazan Region Clinical Hospital in the period from 2006 to 2022. The main group included 39 patients, who were operated by the Desarda technique modified by the authors. The modification consisted in the formation of a flap from the aponeurosis of the external oblique muscle, covering the seminal canal, with fixation of its free end to the inguinal ligament. The control group included 720 patients, 454 and 266 of whom were operated by the Bassini and Lichtenstein techniques, respectively. In order to evaluate the surgical outcomes, a comprehensive examination was performed, including collection of complaints, anamnesis, examination of the postoperative suture, and inguinal region. This included the size, shape, and hernia repairability, if any, dilation of the external inguinal ring, skin condition, painfulness and cough tremor at palpation, and ultrasound examination of the inguinal region. QoL was assessed using the SF-36 (Short Form) questionnaire. Statistical analysis was performed using the Statistica 13 software package (StatSoft, USA). Results. The patients of the main and control groups were divided into those who were admitted as planned and emergency patients. Long-term hernioplasty outcomes in the planned surgery patients were as follows: recurrences after the Desarda technique modified by the authors — 0 out of 24 (0.00%); recurrences after the Bassini technique — 44 out of 310 (14.20%); recurrences after the Lichtenstein technique — 7 out of 181 (3.87%). Long-term hernioplasty outcomes in the emergency patients were as follows: recurrences after the Desarda technique modified by the authors — 0 out of 15 (0,00%); recurrences after the Bassini technique — 31 out of 144 (21.53%); recurrences after the Lichtenstein technique — 4 out of 85 (4.70%). In the planned surgery patients of the main group, 5 QoL indicators were statistically significantly higher in relation to at least one method of hernioplasty of the control group. In the emergency patients, this number was 4 indicators. The absence of recurrences, both in planned and emergency patients, was associated with the non-invasiveness of auto-tissue, preserved non-tension, reduced dependence on the availability of consumables, and improved QoL of patients with inguinal hernias. These factors determine the advantages of the Desarda technique modification proposed by the authors. Conclusion. The application of the Desarda technique modified by the authors reduced the number of recurrences in the postoperative period in inguinal hernia in both planned surgery and emergency patients, improving their QoL. The suggested method of herniorrhaphy ensures reduced dependence on the availability of consumables.