Application hernioplasty " tension-free " in the treatment of strangulated inguinal hernia
Science Articles / / May 10, 2016
Egiev VN Sergeichev AK, Swing VA
problem of surgical treatment of patients with inguinal hernia abdominal uschemlёnnoy relevant today.This is determined by a significant frequency of admission of patients with this disease (50-58%) of the total strangulated ventral hernias.The results are simple ways inguinal canal plasty recommended when strangulated inguinal hernia is not satisfactory.Recurrences at these methods hernioplasty reach different authors 28.5%.
With the advent of synthetic plastic materials such as polypropylene and polytetrafluoroethylene (PTFE) and methods of plastic "tension-free" inguinal canal with the use of synthetic materials (L. Nuhus, Liechtenstein) in elective surgery recurrence rate has fallen sharply and is different authors from0 to 0.5%.Results plastics were first published I. Liechtenstein in 1989.There were reports of treatment of 1000 patients with inguinal hernias.In this group, no recurrence was observed.Septic complications were not observed.99% hernioplasty we
Despite the long history of the use of this technique in routine surgery, remains a contentious issue on expediency of its application in strangulated inguinal hernia.Undetermined place plastic "tension-free" when strangulated inguinal hernia.
The purpose of the study. improve outcomes in patients with strangulated inguinal hernia, through the use of plastic "tension-free"
Material and methods. Since 2001, in the surgical department started development and active use of methods of hernia repair "tension-free" inguinal hernia, including when strangulated.From 2001 to 2003 inclusive, we operated on 52 patients with a diagnosis of strangulated inguinal hernia with hernia repair "tension-free".The share of transactions on the technique "without tension" with strangulated hernia has grown from 7.4% in 2001, 47% in 2002 to 100% in 2003. Among them, women were 2 people, male 50. Age of patients from 28 to78 years (mean age 56.5 years).Operations were filled in 48 cases under local anesthesia, 2 under endotracheal anesthesia with muscle relaxants, 1 under intravenous anesthesia and epidural anesthesia 1 case.As allograft mesh used in one case the polypropylene mesh "Surgipro" firm "Auto Suture", in a perforated plate of polytetrafluoroethylene (PTFE) "ECOFLON" in the remaining 50 the polypropylene mesh "Linteks" firm.
polypropylene mesh was fixed thread № 2/0 "Surgi pro" company "Auto Suture" in 1 case in 51 2/0 polypropylene thread number 1 or number of the company "Medin".In all cases, careful hemostasis used mono or bipolar coagulation.All patients received postoperative antibiotics (synthetic penicillins with aminoglycosides).
Methodology operation. Performed methodology proposed by I. Lichtenstein, but with the obligatory opening of the hernia sac and the revision of its contents, take in the bag, is cut off, the stump as possible mixed up by muscles, spermatic cord is not sutured.When edema tissue, the space between the grid and the preperitoneal fiber and between the grid and aponeurosis drained through-drainage.In one case, resection of the ileum through unsustainable gernitomichesky access was performed.
Results and discussion. duration of intervention is 50 - 120 minutes.an average of 70 min., due to the development of techniques and principles of safety and thoroughness.
observed following postoperative complications: post-operative wound infiltration -2, -1 seroma, edema moshonki- 1. All complications are treated conservatively, reoperation was required.The postoperative period was characterized by an early activation of patients, not the severity of the pain syndrome that contributed to the decline in demand of narcotic analgesics, and in most cases allowed to give in the postoperative period of appointment of narcotic analgesics.Most patients with first rising 6 - 8 hours after surgery.The mean hospital stay was 6.6 days (from W to 14 days) it should be noted that we did not seek early discharge of patients for the purpose of observation.During follow-up for 2 years, there was no recurrence.
Conclusions. Hernioplasty "tension-free" in Lichtenstein has a worldwide success, with a planned inguinal hernia for the simplicity, affordability, versatility, low relapse rate and rapid rehabilitation of patients gives comparable results and strangulated inguinal hernia.