Optimization of surgical treatment for Nyhus type II indirect inguinal hernias - short-term results

Relevance. Inguinal hernias are one of the most common surgical diseases, often found in working age men. Despite a significant decrease in the number of relapses after tension-free hernioplasty, the severe pain syndrome, the high frequency of edematous and hemorrhagic syndromes in postoperative period are often founded. Improving the surgical treatment of inguinal hernias reduces the likelihood of the above-mentioned consequences of operations.Goal. Improve the immediate treatment outcomes with oblique intracanal inguinal hernias by developing and modifying methods of prosthetic hernioplasty.Material and methods. A method of inguinal hernioplasty (a method for the prevention of scarring of the spermatic cord (patent for invention No. 2655541 dated 28.005.2018) and a modification of the method of forming the Cux window (rationalization proposal No. 360 adopted by the SamSMU dated 06/29/2016) have been developed. The immediate results of the application of the developed techniques in 60 patients (the main group) were analyzed. The control group consisted of 60 patients operated according to the classical Lichtenstein technique. The pain level of syndrome on a visual analog scale, the severity of edematous syndrome, hemorrhagic complications in the area of surgery, ultrasound data on size measurements of the testicle and scrotum wall, detection of accumulations of serous fluid, and the fit of the implant were assessed and analyzed.Results. The immediate results in the main group were better than in the control group. A decrease in the level of pain syndrome after 1 day and 3 days after surgery was noted. Reliable data were obtained on the positive effect of the proposed surgical treatment option on edematous syndromes, the decrease of hemorrhagic complications.Conclusions. The application of the developed techniques made it possible to improve the immediate results of treatment by stitching the implant from above to the aponeurosis of the external oblique abdominal muscle, reducing the traumatization of the elements of the spermatic cord during the allocation of the hernial sac, the suction capacity of the peritoneum of the inverted section of the hernial sac.