Diagnostic value of laparoscopic inguinal allohernioplasty in detection of occult hernias of inguinal region

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Abstract

Aim. To evaluate diagnostic value of laparoscopic inguinal allohernioplasty in identification of occult forms of hernias of the inguinal region.

Materials and Methods. The study was conducted on the basis of the results of surgical treatment of patients with inguinal hernias on the base of the Department of Hospital Surgery of RyazSMU in Ryazan State Emergency Care Hospital and on the base of the Department of Surgery, Obstetrics and Gynecology of Additional Postgraduate Education Faculty in Ryazan Regional Clinical Hospital, from 2015 to 2020 (n=207). Operations were performed with the absence of contraindications to narcosis and carboxyperitoneum, and if patients desired to be operated on by the proposed method. In all the patients included into the study, hernioplasty was performed using laparoscopic approach, with preperitoneal placement of the endoprosthetic mesh. For purity of the experiment, only polypropylene meshes were used. Standard meshes from monofilament polypropylene were used with surface density 65-80 g/m2 and volumetric porosity 80-85%. Meshes 15x15 cm dimension were used with cut angle with 7.5A cm catheti.

Results. Of 207 patients, 28 were operated on for bilateral inguinal hernias. Only in one of them hernia was diagnosed in the preoperative stage. In the rest 27 patients, an occult hernia was found opposite to the previously diagnosed side. In 17 patients, besides hernias diagnosed in the preoperative and intraoperative stages, occult hernias were detected in the process of dissection of the preperitoneal space.

Conclusion. Laparoscopic inguinal allohernioplasty permits to diagnose occult hernias that were not detected in the preoperative examination: femoral, obturator, inguinal hernias on the contralateral and/or unilateral side. This permits to perform hernioplasty taking into account the intraoperative finding, in one surgical procedure without subjecting the patient to repeated hospitalization, narcosis and operation.

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About the authors

Oleg V. Zaitsev

Ryazan State Medical University; Ryazan Regional Clinical Hospital

Email: ozaitsev@yandex.ru
ORCID iD: 0000-0002-1822-3021
SPIN-code: 4556-7922
ResearcherId: R-6830-2016

MD, PhD, Associate Professor, Professor of the Department of Surgery, Obstetrics and Gynecology of the Faculty of Additional Professional Education; Head of the First Surgical Department

Russian Federation, Ryazan

Anna V. Koshkina

Ryazan State Medical University; Ryazan Regional Clinical Hospital

Author for correspondence.
Email: mokrova_ann@mail.ru
ORCID iD: 0000-0002-8824-7782
SPIN-code: 9153-5364
ResearcherId: AAM-9111-2020

PhD-Student of the Department of Surgery, Obstetrics and Gynecology of the Faculty of Additional Professional Education; Surgeon of the First Surgical Department

Russian Federation, Ryazan

Dmitriy A. Khubezov

Ryazan State Medical University; Ryazan Regional Clinical Hospital

Email: support@rokb.ru
ORCID iD: 0000-0003-2688-6842
SPIN-code: 8800-2190
ResearcherId: S-5105-2016

MD, PhD, Professor, Head of the Department of Surgery, Obstetrics and Gynecology of the Faculty of Additional Professional Education; Surgeon, Chief Physician

Russian Federation, Ryazan

Vladimir A. Yudin

Ryazan State Medical University; Ryazan Regional Clinical Hospital

Email: vydin@yandex.ru
ORCID iD: 0000-0002-9955-6919
SPIN-code: 1463-2810
ResearcherId: B-6212-2018

MD, PhD, Professor, Professor of the Department of Surgery, Obstetrics and Gynecology of the Faculty of Additional Professional Education; Surgeon of the Second Surgical Department

Russian Federation, Ryazan

Vladimir V. Barsukov

Ryazan Regional Clinical Hospital

Email: doctor-barsukov@mail.ru
ORCID iD: 0000-0001-5490-9293
SPIN-code: 9312-8750
ResearcherId: AAM-9919-2020

Surgeon of the First Surgical Department

Russian Federation, Ryazan

References

  1. Dietz UA, Hamelmann W, Winkler MS, et al. An alternative classification of incisional hernias enlisting morphology, body type and risk factors in the assessment of prognosis and tailoring of surgical technique. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2007;60(4):383-8. doi:10.1016/ j.bjps.2006.10.010
  2. Dietz UA, Winkler MS, Härtel RW, et al. Importance of recurrence rating, morphology, hernial gap size and risk factors in ventral and incisional hernia classification. Hernia. 2014;18(1):19-30. doi: 10.1007/s10029-012-0999-x
  3. Tarasenko SV, Kopeykin АА, Akhmedov ShI, et al. Comparative analysis of endoscopic treatment of inguinal hernias. I.P. Pavlov Russian Medical Biological Нerald. 2015;3:94-8. (In Russ).
  4. Bushnin SS, Kropacheva EI, Kachalov SN. Effective methods of inguinal hernia repair. Far East Medical Journal. 2009;(1):114-8. (In Russ).
  5. Fitzgibbons RJ, Salerno GM, Filipi CJ, et al. Laparoscopic intraperitoneal onlay mesh technique for the repair of an indirect inguinal hernia. Annals of Surgery. 1994;219(2):144-56. doi: 10.1097/00000658-199402000-00006
  6. Farmer L, Ayoub M, Warejcka D, et al. Adhesion formation after intraperitoneal and extraperitoneal implantation of polypropylene mesh. The American surgeon. 1998;64(2):144-6.
  7. Tarasenko SV, Zaytsev OV, Akhmedov ShI. Occult hernia – laparoscopic hernia repair advantage (TAPP). Nauka Molodykh (Eruditio Juvenium). 2015;(4):70-2. (In Russ).

Supplementary files

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2. Fig. 1. A cutout mesh polypropylene endoprosthesis

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3. Fig. 2. Intraoperative picture of an occult obturator hernia (shown by the arrow)

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Media Registry Entry of the Federal Service for Supervision of Communications, Information Technology and Mass Communications (Roskomnadzor) PI No. FS77-76803 dated September 24, 2019.



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