Tactical and technical features of the treatment of strangulated inguinal hernias

Abstract

The results of treatment of 136 patients with strangulated inguinal hernia were analyzed. As in the main and in the control group the majority were men mostly with oblique inguinal hernias. When assessing the retrospective material the regularities in development of complications prejudice, and postoperative complications are associated primarily with temporal parameters. Among patients admitted after 8 hours from the time of infringement, has significantly increased the number of complicated forms of infringement, as well as complications in the postoperative period. In the control group there was no single diagnostic and treatment algorithm and were not used endovideosurgical techniques. It was found that the majority of unsatisfactory results of treatment are associated with untimely performed surgical interventions, including with rare forms of infringement. To improve the results of treatment of patients in the prospective group was developed and introduced into clinical practice differential diagnostic and treatment algorithm that includes ultrasound, CT of the anterior abdominal wall and abdomen and diagnostic laparoscopy. In the study, it was shown that the infringement of inguinal hernia is not a contraindication to prosthetic hernioplasty methods, provided the viability of the strangulated organ. The developed indications and contraindications to the use of endovideosurgical techniques and algorithm to evaluate the viability of the strangulated organ. The use of the proposed diagnostic and treatment strategy allowed to reduce the level of complications from 25 to 1,9%, local complications from 29,8 to 5,7%, while the fatality rate from 8,3 to 0% (p<0,05).

Keywords

strangulated inguinal hernia / diagnostic algorithm / ultrasound examination of the abdomen / diagnostic laparoscopy / Liechtenstein operation / laparoscopic hernioplasty / postoperative complications

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