Surgical treatment of inguinal hernia

Experience in 234 operations for inguinal hernias is analysed. A differentiated pathogenetic approach to the surgical treatment of these hernias leads to considerable decrease in the number of recurrences. A method of plasty of the inguinal canal with the use of an 8-shaped suture is proposed; it is distinguished by simple techniques, minimum traumatism, and the possibility of abiding by the principle of joining relatively homogeneous tissues and by that of a pathogenetic approach to the management of inguinal hernias.     

Surgical treatment of inguinal hernia

Results of experimental hernioplasty with "Regeneration stimulator" in 38 dogs are presented. Reduction of postoperative period of abdominal wall reparation, stimulation of muscular-aponeurotic regeneration were revealed. Experience of surgical treatment of 49 patients with inguinal hernias is presented where surgical technique combined repair of anterior abdominal wall defect by different methods with intraoperative introduction of "Regeneration stimulator" in the zone of plastic reconstruction. There were no recurrences of hernias in the period from 1 to 3 years that permits to recommend wide use of this method.     

Surgical training and inguinal hernia repair

AIMS: To evaluate influence of surgical experience on inguinal hernia repair. PATIENTS: From 1997 to 2003, 380 patients (mean age 55 years old) with primary unilateral inguinal hernia were treated by Lichtenstein technique. METHODS: In this retrospective study, surgeons were classified in three groups: group 1: hernia repair was performed by an experimented surgeon (consultant or senior registrar) and a young surgical trainee (resident) (161 cases); group 2: surgery was performed by a junior surgeon (resident) under the control of an experimented surgeon (135 cases) and in the group 3 (84 cases), Lichtenstein technique was performed by two residents, alone, supervised by an experimented surgeon, in the operative room. Evaluation criterion were operative time, hospital stay, morbidity, time to return to normal and professional activities, recurrences and chronic pain with a follow up of, at least, 2 years. RESULTS: The three groups were comparable in term of socio economic data, hernia and follow up. The only significant (P=0.01) difference concern operative time which increased from 20% for group 2 and 3 (residents) compared to the group 1. There was also no difference between junior and senior resident. CONCLUSION: Lichtenstein hernia repair should be performed by young surgeon in training alone in condition of precise teaching organization and experimented surgeon supervision. For patient, in this condition, there is no trouble in term of surgical results.     

女性腹股沟疝的特点及手术的相关问题

目的 探讨女性腹股沟疝的特殊性及相关手术的问题和处理方法 .方法 分析近8年间的女性腹股沟疝(除外股疝)43例,全部患者均经无张力疝修补手术治疗.结果 发现女性患者的发病侧与男性一样,也是右侧为主,斜疝的比例高达86.0%.同时本组有比较高的鞘突管病变的发生比率(7例,16.3%)和圆韧带病变(3例,7.0%).成年女性中滑动疝的出现率不高.结论 在腹股沟疝的发病方面女性同男性一样,右侧病变和斜疝为主.女性患疝的同时伴发鞘突管未闭合病变者较多.术中应考虑探查股管.     

Special aspects of neonatal inguinal hernia and herniotomy

In a retrospective study, we examined 23 pre-term infants (18 boys, 5 girls) with a median weight of 1540 g (range 720–2770 g) and a median age of 32 weeks (range 25–36 weeks) gestation, who were subsequently operated on after a median of 65 days (range 20–121 days) for 33 inguinal hernias. The infants were evaluated with respect to concomitant diseases as well as peri- and postoperative complications. The following surgical procedure was used in all patients: a high suture ligation after excision of the hernia sac, followed by closure of the groin according to Grob in boys, and according to Bassini in girls. Co-morbidity was high in the pre-term infants, both pre- and perinatally. Despite this high co-morbidity and a high rate of emergency operations due to incarcerations, the postoperative complication rate was very low. However, the rate of testicular atrophy (10%) and recurrent inguinal hernia (9%) registered by us in the median follow-up of 575 days (range 105–1118 days) was much higher than that seen in older infants. Nevertheless, based on the low perioperative complication rate registered in the present study, we postulate that early surgery is tenable in pre-term infants despite the high co-morbidity and is even meaningful for the purpose of reducing the high rate of incarceration and testicular atrophy. The high recurrence rate in pre-term infants appears to be related to the numerous concomitant diseases in these patients, the resultant increase in intra-abdominal pressure and the small size of anatomical structures. Electronic Publication     

Surgical treatment of the giant inguinal hernia

Summary The authors present 5 cases of giant inguinal hernias observed over a ten-year period (1987–1997) in 1000 patients undergoing inguinal hernia operations. Such hernial formations are rare today (only 5% of the cases) thanks to better hygienic conditions and better hernioplasty techniques, carried out with local anesthesia, that encourage patients to undergo an operation shortly after diagnosis. Of the 5 cases reported, all primary hernias, 4 were implanted with a dacron-mersilene lattice prosthesis by the Rives technique, while in one case the Shouldice technique was used. The problem the authors found in operating on these large hernial formations relates mainly to orchidectomy and whether or not to carry out a reductive plastic surgery of the scrotum after the operation. Orchidectomy, which was performed in all 5 patients, was often a necessity because of unusual length of the spermatic cord, atrophy of the testicle and also to allow the hernioplasty to be carried out more easily. Reductive plastic surgery of the scrotum, carried out in 2 of the 5 cases presented, becomes necessary when, due to inelasticity, there is no or insufficient retraction of the dartos muscle, thus leaving an abnormally huge scrotum that in time may turn into a form of elephantiasis due to lymphedema, and for which an unpleasant re-operation often needs to be carried out.     

Surgical repair of primary or recurrent inguinal hernia by prosthesis and polypropylene plug]

This paper reports about experience with the cure of 2,000 primary hernia by the insertion of a patch, and of 1,400 recurrent hernias with obturation and a plug. All operations were performed under local anesthesia and with short hospitalization. There was almost no recurrence (2/2,000) of primary hernias, and only 1% for recurred hernias.