SURGICAL TREATMENT OF RECURRENT INGUINAL HERNIA

Abstract

Introduction. Postoperative hernia recurrence is one of the least desirable outcomes of surgical treatment. In the case of inguinal hernias, the rate of postoperative recurrence ranges from 5.9 to 35%. Obviously, such a high percentage of postoperative relapses cannot satisfy surgeons, and indicates the urgency of the problem. Aim. To analyze the effectiveness of various methods of hernioplasty in the treatment of recurrent inguinal hernias. Materials and method. An analysis of the treatment of 38 patients with recurrent inguinal hernia was conducted. All of them were treated in the general surgery department of the multidisciplinary clinic named after. N.I. Pirogov (St. Petersburg) from 2014 to 2021. Of the 38 patients, 36 were male and 2 were female. The age of the patients ranged from 27 to 76 years; the average age was 64±7.35 years. Results. In cases where a relapse developed after endovideosurgical hernioplasty TAPP (Trans Abdominal Pre-Peritoneal) or TEP (Тotally Еxtraperitoneal), an anterior approach was used during reoperation, hernioplasty was performed according to Lichtenstein. Of the 29 (76%) patients who had previously undergone surgery using an anterior approach, in 23, prosthetic laparoscopic hernioplasty TAPP was chosen to eliminate the relapse. In six observations, contraindications to laparoscopic surgery were noted in patients with recurrent inguinal hernia. These patients underwent secondary hernioplasty using an anterior approach, with excision of the old postoperative scar, Lichtenstein operation. In nine (24%) patients who underwent  endovideosurgical intervention as the first operation, in seven observations an alternative anterior approach was chosen to eliminate the relapse — Lichtenstein hernioplasty was performed. In two cases, patients with recurrent hernia after endovideosurgical hernioplasty using a transabdominal approach underwent TEP. Conclusions. Refusal of tension hernioplasty techniques and the use of synthetic (polypropylene) explants improves the immediate and long-term results of surgical treatment of patients with recurrent inguinal hernia and gives good functional results of the operation and reduces hospitalization time. The use of an alternative surgical approach during reoperation avoids contact with scar tissue and, as a result, reduces the incidence of postoperative complications. If a synthetic explant was installed during the primary operation, and the relapse is associated with its displacement or rupture, in most cases there is no need to remove it during a second operation. The use of TAPP in the treatment of patients with recurrent inguinal hernia makes it possible to perform one-stage bilateral hernioplasty in cases where the patient has a bilateral inguinal hernia.