Yatsuk K. Differential Approach to the Use of Mesh Implants in the Treatment of Patients with Inguinal Hernias

The dissertation is devoted to substantiating the effectiveness of a differentiated approach to the use of mesh implants in the surgical treatment of inguinal hernias through a comparative analysis of non-mesh hernioplasty according to Desarda, a hybrid Desarda technique with mesh implantation, and the classical Lichtenstein repair, taking into account intraoperative criteria for method selection, as well as immediate and long-term treatment outcomes. A conceptually justified and clinically tested hybrid modification of Desarda hernioplasty with integration of a mesh fragment has been developed, combining the principles of tension-free autologous repair and localized prosthetic reinforcement of the posterior wall of the inguinal canal, specifically designed for the treatment of hernias with pronounced defects and reduced aponeurotic quality. A differentiated intraoperative approach to selecting the method of open hernioplasty has been substantiated, allowing selective application of either non-mesh Desarda repair, hybrid Desarda repair with integrated mesh fragment, or classical Lichtenstein mesh repair depending on the anatomical condition of the external oblique aponeurosis and the size of the posterior wall defect. It has been demonstrated that the use of the hybrid Desarda method with mesh integration in patients with more complex inguinal hernias provides immediate and long-term treatment outcomes comparable to classical Lichtenstein repair, despite larger defect size and more challenging baseline anatomical conditions. It has been established that localized use of a mesh fragment within the hybrid Desarda method allows reliable reinforcement of the posterior wall of the inguinal canal without a significant increase in postoperative complications, chronic pain, foreign body sensation, or long-term recurrences. The obtained results complement existing data on the possibilities of individualizing surgical treatment of inguinal hernias and expand the current scientific knowledge regarding the role of non-mesh, mesh, and combined techniques in modern open hernioplasty.