RECURRENCE OF INGUINAL HERNIA AFTER AUTOPLASTY, CAUSES AND SURGICAL TREATMENT

Abstract

Introduction. Inguinal hernias are one of the most common surgical diseases in humans. Surgical interventions for inguinal hernias rank first in frequency among planned surgical procedures. Despite the development of modern methods of hernioplasty, the use of tension-based repair of the inguinal canal remains widespread, and with it, the risk of recurrence of inguinal hernia remains a significant clinical problem. Therefore, the study of risk factors for recurrence is still relevant today.

Aim. To study the causes of recurrence of inguinal hernias after autoplasty and to determine ways to improve the outcomes of surgical treatment for patients with this pathology.

Materials and methods. This study presents the results of surgical treatment in 842 patients with recurrent inguinal hernias after tension repair, aged 21 to 79 years. Recurrent oblique inguinal hernias R1 were found in 392 (46.6%) patients, direct R2 in 379 (45%), and hernias with a large defect and other aggravating factors R3 were observed in 71 (8.4%) patients.

Results and discussion. It was found that the cause of recurrence of direct inguinal hernia after autoplasty in 39.3% of patients was the inadequately chosen method of the initial operation, which aimed at repairing the anterior wall of the inguinal canal, as well as age-related cicatricial-atrophic changes in the structures of the inguinal canal. Recurrence of oblique inguinal hernia in 39.7% of patients occurred due to cicatricial-atrophic changes in the structures of the inguinal canal resulting from tension-based repair of the anterior wall of the inguinal canal and technical errors made during the operation.

During reoperation, the choice of the method for reconstructing the inguinal canal was based on the type of hernia, the type of recurrence, the method of previous repair, the height of the inguinal gap, and the degree of atrophic changes in the muscular-aponeurotic structures of the inguinal canal, following the recommendations of the European Hernia Society (EHS).

Reconstruction of the inguinal canal at the first recurrence of the hernia in 659 (78.3%) patients with R1 and R2 was performed using the Lichtenstein method. At the second recurrence, in 83 (9.9%) patients with R1 and R2, the modified Lichtenstein method was applied, incorporating correction of the deep inguinal ring and suturing of the transverse fascia without tension. Laparoscopic TAPP at the first recurrence of R1 and R2 was performed in 20 (2.4%) patients. In 64 (7.6%) patients with R2 and R3 recurrent hernias with a destroyed posterior wall of the inguinal canal, open preperitoneal allohernioplasty was performed using a method developed in the clinic. In 9 (1%) patients with R3 multiple recurrent hernias and a destroyed inguinal ligament, open preperitoneal allohernioplasty with ligament repair using a method developed in the clinic was performed. In 7 (0.8%) patients with R1 and R2, who had inflammatory processes in the surgical area and were at risk of purulent complications, Bassini repair was performed.

Conclusions. Improving the outcomes of surgical treatment for patients with inguinal hernias can be achieved through the individualized selection of a pathogenetically justified, «tension-free» method of allohernioplasty aimed at strengthening the posterior wall of the inguinal canal, the technically correct performance of the procedure, and the more widespread use of TAPP.