Immediate and late follow-up results of auto- and alloplastic operations in inguinal hernias

Abstract

Objective. To conduct a scientific investigation for comparative investigation of results of auto- and allohernioplastic operations. Materials and methods. The investigation was based on analysis of postoperative results in 400 patients, ageing 16 - 85 yrs old, to whom in Scientific Surgical Centre named after Acad. M. A. Topchibashev and the City of Shirvan Central Hospital in 2009-2019 yrs period surgical treatment for inguinal hernia was conducted. Depending on the procedure of hernioplasty applied, the patients were divided into two Groups. In a control one (n=200) the operations were performed, using open autohernioplasty only. In the main Group (n=200) open procedure and laparoscopic allohernioplasty, using different synthetic nets, were applied. Results. Comparative analysis of intraoperative, postoperative immediate and late follow-up results in the patients after auto- and allohernioplasty was done. In accordance to criteria of the intraoperative and immediate postoperative morbidity rate the statistically meaningful differences between two groups of patients were absent. Good late results of allohernioplasty were noted in (71.8 ± 3.41)%, satisfactory - in (17.2 ± 2.86)%, poor - in (11 ± 2.36)% patients (p<0.05); allohernioplasties - accordingly, in (80.2 ± 2.91)%, (16 ± 2.68)% and (3.8 ± 1.39)% patients (p<0.05). Comparative analysis done have shown the statistically much better results of allohernioplasty. Recurrences after allohernioplasty were observed in 3 times less frequently - 3.8%, and after autohernioplasty this index have constituted 11% (p < 0.05). Сomparative analysis of late follow-up results of various autohernioplastic methods have shown good results of Postemskyi method in (76.7 ± 7.72)% patients, and of Postempskyi method in our modification - in (88.9 ± 7.41)% patients. Good results of autoplasty in other methods were noted merely in equal quantity of the patients - in up to 70%, and statistically significant difference was absent. Conclusion. Basing on own results obtained, we recommend to perform autohernioplasty of the inguinal channel anterior wall in accordance to Girard-Sposokukotskyi method with Kimbarovskyi suture for oblique inguinal hernias, while in direct inguinal hernias, for strengthening of posterior wall, - Postempskyi method in our modification. In large and recurrent hernias in patients of middle and senile age it is expedient to apply a Lichtenstein plasty in our modification. Total extraperitoneal or transabdominal preperitoneal plasty is recommended if technical installments needed and the physician’n laparoscopic skills are available.

Keywords

• inguinal hernia; autohernioplasty; allohernioplasty; laparoscopic hernuoplasty.