THE PROBLEM OF CHOOSING A METHOD FOR RECURRENT INGUINAL HERNIA REPAIR

Inguinal hernia repair is the most popular surgery performed by general surgeons around the world. The recurrence rate with various inguinal hernia repair techniques is 15%. The use of laparoscopic techniques in the treatment of inguinal hernias has significant advantages over open surgery, since it can significantly reduce pain, achieve excellent cosmetic results and shorten the duration of hospitalizations. At the same time, the recurrence rate after using laparoscopic techniques reaches 8.9%. The aim of this work is to determine the optimal method of surgical intervention for recurrent inguinal hernias. In the period from 2007 to 2011, a comparative randomized study was conducted, included 82 patients with recurrent inguinal hernias. Initially, all 82 patients were operated using Liechtenstein method with polypropylene mesh. All 82 patients with recurrent inguinal hernias were divided into two groups, patients in group I were operated on using laparoscopic methods (TAPP), in group II, repeated hernioplasty was performed using a modified Lichtenstein technique. In group I, the duration of the operation was 87±12 minutes. There were no serious intraoperative complications in group I. In group II, the average duration of the operation was 112±15 minutes. Complications in group II: severe pain syndrome was observed in 29 patients (69%), seroma developed in 15 patients (35.7%), in 4 patients (9.5%) hernia recurrence was revealed. Thus, patients who have been operated on using laparoscopic methods have certain advantages in terms of the duration of the operation, the number of postoperative complications, the presence of pain syndrome, and most importantly, these patients do not have a recurrent hernia. The results of repeated interventions in patients with recurrent inguinal hernias who did not use mesh implants were analyzed. The results obtained show the advantage of laparoscopic methods in reoperations, which was accompanied by fewer complications and reccurences. A rather difficult problem of choosing the optimal method of re-interventions in patients with relapses after laparoscopic hernioplasty. In 16.7% of patients, repeated laparoscopic hernioplasty turned out to be impossible due to technical difficulties and they had to switch to open Lichtenstein plasty. At the same time, in almost half of patients with recurrent inguinal hernias, it was possible to successfully perform repeated laparoscopic hernioplasty with good immediate and long-term results.