The differetated approach in treatment of patients with inguinal hernia

We performed a retrospective analysis of 778 cases of uncomplicated inguinal hernias. In the group of patients there were 717 men (92,2%). Most hernia patients - 477 (61,3%) were elderly and senile. Was performed a comparative analysis of clinical data of three groups with 301 patient (young and middle age to 59, 325 elderly (60-74 y) and 152 of senile (75 and older), and was developed the diagnostic algorithm, included ultrasound evaluation of inguinal and iliac region, and, in elderly and senile patients, additionally, clinico-instrumental and laboratory investigations of cardiovascular, pulmonary, urogenital and other systems of organs. Matching of character and frequency of postoperative complications coupled with morphological and immunohystochemical investigations of transverse fascia let us to provide rationalization technique in patients with inguinal hernia. Selection criteria of optimal surgical technique includes grade of local changes in inguinal-illiac region Nyhus, and character and severity dysfunction of organs and systems of vital importance. According to developed statement, in young patient with not large hernias type 1.2 the Shouldice technique under local anesthesia is mandatory. In elderly and senile patient with hernias (type 3a, b1-4 and type 4) and weakness of the inguinal floor is mandatory tension-free plastic. In young and middle-aged patients with similar types of hernias (type 3.4.) and without dysfunction of organs and systems is possible to perform endoscopic videoendoscopic interventions - ТАРР or ТЕР. Surgery in elderly and senile patient should be carried out with participation of anesthesiologist, because it reduces prevalence of common complications in early postoperative period twice.