Svyrydovsky S. A comparative estimation of efficiency of alloplasty at inguinal hernia

The dissertation presents the results of surgical treatment of 276 patients with inguinal hernia, which depending on the surgery were divided into 4 groups. In I group of 70 patients fulfilled the traditional operation Lichtenstein, in II group - 72 patients - modified our operation Lichtenstein, the essence of which is mandatory visualization of nerves inguinal canal before fixing mesh to prevent injuries and suturing, in group III - 69 patients - an open preperitoneal plastic, in IV - 65 patients - technique TAPP. For research the effectiveness of these alloplastic we were conducted a comparison on the following criteria: duration of the operation, the frequency and nature of complications, pain intensity after surgery, duration of bed-day term disability, quality of life using the MOS SF-36. To evaluate the results, we compared the results of research in pairs of I group with II group, and III group - with IV group. As well there was analyzed group of 29 patients with chronic postoperative inguinal pain. 15 patients was treated conservatively with positive dynamics, 14patients was operated: triple neurotomy - 11 patients, mesh explantation - 3 patients. There was examined 13 (92.9%) operated patients: 8 (61.5%) patients - recovery, 4 (30.8%) - significant reduction of pain, 1 (7.7%) - a slight improvement. We performed histological examination of the material that has been taken in these 14 patients. Morphological changes are characterized by: progressive atrophic processes in muscle, connective tissue and fatty replacement of muscle tissue and the formation of nerve; overgrowth of fibrous tissue between the collagen and elastic fibers, there are numerous nerve fibers, around which a large amount of fibrous tissue (perineural fibrosis). According to results of comparison, the optimal variant of surgical treatment of inguinal hernias are TAPP methodic and modified Lihtenstein operation, which is proved by best results according to most criterions.