Choice of Hernioplasty Method in Patients with Inguinal Hernias

Abstract

Purpose of the study – to elaborate an algorithm for the choice of hernioplasty method in patients with inguinal hernias on the basis of analysis of the pathological changes, which have appeared as a result of the hernia formation, and of the features observed in anatomic structure of the inguinal canal. During the period of 2016 to 2022, 306 patients with inguinal hernias, aged 16 to 82 years, were operated on at Bukhara regional multidisciplinary medical center. Mostly, they were male patients – 260 (85%). Primary inguinal hernias were diagnosed in 260 (85%), recurrent hernias in 46 (15%) patients. Used in the study was the inguinal hernia classification by Gilbert. According to this classification and with an account for the inguinal interspace height and a degree of atrophic changes in muscle-aponeurotic structures of the inguinal canal, we worked out the following algorithm for the choice of hernioplasty method. In case of hernias of types I, II, III, IV and V with the preserved posterior wall of the inguinal canal, with the lowered inguinal interspace (up to 2 cm) and lacking atrophy in muscle-aponeurotic structures of the inguinal canal, either autoplasty of the posterior wall of the inguinal canal or transabdominal preperitoneal laparoscopic hernioplasty is indicated; alloplasty by Liechtenstein method is possible at patient’s will. In case of hernia types VI and VIII with the lowered inguinal interspace and lacking atrophy in muscle-aponeurotic structures of the inguinal canal, either alloplasty of the posterior wall of the inguinal canal by Liechtenstein method or PHS is indicated. For hernia types III, IV, V, VI, VII and VIII with the higher inguinal interspace (3 to 5 cm) and existent atrophy in muscle-aponeurotic structures of the inguinal canal, either allohernioplasty by Reeves method or preperitoneal allohernioplasty of inguinal and femoral hernias is indicated. Using the algorithm proposed for the choice of hernioplasty method, 21 (6.8%) autoplastic and 285 (93.2 %) alloplastic operations were performed at our Clinic. During the postoperative period, infiltrate in the wound area and serous inflammation were observed in 6 (2.1 %) patients, moderate edema of testicle in 3 (2.8%) and suppuration in 1 (0.3%) patients. Hernial recurrences occurred in 3 (1.05%) patients out of those 285 examined within 1 to 5 years. An improvement in the surgical treatment results in patients with inguinal hernias can be achieved by means of the individual choice of hernioplasty method with an account for pathological changes in the posterior wall of the inguinal canal and the inguinal interspace height, technically adequate performance of the operation itself, and the use of up-to-date mesh implants. The algorithm proposed for the choice of hernioplasty method allows for minimization of the recurrence rate of inguinal hernias. The present-day classifications of inguinal hernias do not give complete information about pathological changes in the inguinal canal and need to be supplemented.