The transabdominal preperitoneal aloplasty optimization for recurrent inguinal hernias after liechtenstein surgery

The aim — to improve the surgical treatment effectiveness for recurrent inguinal hernias after the Liechtenstein surgery by transabdominal preperitoneal alloplasty optimizing.Materials and methods. The surgical treatment results of 65 patients with transabdominal preperitoneal alloplasty for relapses after the Liechtenstein surgery in the Department of Surgery, for the period of 2012 — 2018 has been analysed. The patient’s age ranged from 19 to 74 years (mean age was 51.6 ± 1.2 years). All patients were men. Concomitant pathology was noted in 27 patients (41.5 %). Relapses after the Liechtenstein surgey has been developed after 3 months in 18 patients (27.7 %), after 6 months in 38 (58.4 %), after 12 months 9 (13.9 %). According to the Campanelli G. classification (2006) patients were devided into 3 groups: the first group (R1) included 18 (27.7 %), the second (R2) — 33 (50.7 %) and in the third (R3) ‑14 patients (21.5 %). Depending on the transabdominal preperitoneal alloplasty method, patients were divided into 2 groups. The first group 32 patients were operated by the classical transabdominal preperitoneal alloplasty, in the second are 33 patients was performed by improved transabdominal preperitoneal alloplasty. This method differed from the classical one by additional mobilization of the upper peritoneal flape upward by 3 — 4 cm. The mesh was introduced into the abdominal cavity by 3 — 4 cm wider (12 ´ 15 cm). The mesh was fixed by standard method, with an additional glue fixation on the lower edge.Results and discussion. In group I, in the early postoperative period, 3 (9.3 %) patients had serum cysts on the side of the operation, subcutaneous hematomas occurred in 4 (12.1 %). In the late postoperative period, 2 (6.2 %) patients experienced chronic inguinal pain. Recurrence was diagnosed in 3 (9.3 %). In group II, in patients undergoing advanced transabdominal preperitoneal alloplasty the serum cysts was in 4 (12.1 %) cases, subcutaneous hematomas were reported in 4 (12.1 %) patients. In the distant period, chronic inguinal pain was diagnosed in 1 (3.1 %) patient, no recurrence was observed.Conclusions. The use of advanced transabdominal preperitoneal alloplasty in the treatment of recurrent inguinal hernias after the Liechtenstein surgery, due to the wider coverage of the inguinal region with the mesh implant, has advantages over the classic transabdominal preperitoneal alloplasty and reduces the inguinal hernia recurrence rate from 9.3 % in the 1st group, to no relapse in the 2hd group