INGUINAL HERNIAS. MODERN APPROACH TO SURGICAL MANAGEMENT
Authors: Pyptіuk O. V. , Pylypchuk V. I. , Bogush A. E. , Zhabrovets D. D. 
Published: January 2025

During the period of 2019-2024, 1,881 surgical interventions for inguinal hernia were performed in the surgical departments of the Ivano-Frankivsk Central City Clinical Hospital of the Ivano-Frankivsk City Council and the Kaluska Central District Hospital of the Kalusa City Council. There were 1669 men (88.7%), 201 women (11.3%). The age of the patients ranged from 18 to 88 years, with an average of 55.8±6.4 years. Before the operation, all patients underwent an objective examination of the abdominal cavity and inguinal region, as well as standard laboratory tests.
For the preliminary assessment of the hernia area and hernia contents, 88.8% of patients underwent ultrasound examination of the abdominal cavity and the site of the disease, and 5.9% underwent computed tomography. In 62.6% of patients, the hernia was located on the right, 37.4% on the left. In 90.1% of patients the hernia was operable, in 9.9% it was pinched. Indications for surgical intervention were the presence of symptomatic and asymptomatic inguinal hernias in patients. However, some patients (with severe concomitant cardiovascular, pulmonary, renal pathology, decompensated diabetes, obesity, etc.) followed the tactics of "watchful waiting". We adhere to the point of view that the main reason for the occurrence of a hernia defect in the inguinal region is the weakening of the back wall, therefore, the use of plastic surgery of the back wall of the inguinal canal is pathogenetic. The key question regarding inguinal hernia repair today is the following: taking into account recurrence, pain, learning curve, postoperative recovery and cost, which operation should be preferred for unilateral uncomplicated inguinal hernia: open with mesh (Lichtenstein) or laparoendoscopic (TEP and TAPP)? Operative intervention in 1277 (96.1%) patients was performed using spinal anesthesia, in 52 (3.9%) - under general anesthesia. All patients were operated on on the day of hospitalization. Open methods of plastic surgery were used in 1,737 (91.3%) patients: the Lichtenstein method - 1,329 (70.6%). We consider the use of a polypropylene mesh with a size of at least 7.5 × 15 cm to be a prerequisite for effective plastic surgery. The average duration of the operation is 40 minutes. After Lichtenstein's operation in the early postoperative period, seromas occurred in 38 (1.3%) patients, hematomas in 4 (0.3%), infection of postoperative wounds did not occur. Such a low level of complications can be explained by precise surgical technique and, in some cases, by the use of active wound drainage. The intensity of postoperative pain was 4-5 points (on a visual analog scale). Bassini's method - 276 (14.6%), Sholdice's method - 16 (0.8%), Postemskyi's method - 15 (0.5%). Laparoscopic transabdominal preperitoneal plastic surgery (TAPP) was performed in 165 (8.7%) patients. In laparo-endoscopic hernioplasty, we use "heavy meshes", especially in cases of large and direct hernias, to reduce the recurrence rate. "Light mesh" is not recommended because their use does not reduce the risk of postoperative pain, but increases the risk of recurrence. After TARP surgery, seroma occurred in only 1 (0.5%) patient in the early postoperative period, there were no hematomas and infection of postoperative wounds. The intensity of postoperative pain was 2-3 points (on a visual analog scale). Return to normal physical activity in 7.0±1.3 days. Early postoperative complications and the incidence of chronic inguinal pain after laparoscopic operations are lower than after Lichtenstein operations.