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41
I. SURGERY
COMPARATIVE ANALYSIS OF THE RESULTS OF PLASTIC INGUINAL HERNIA LAPAROSCOPIC AND TRADITIONAL METHODS
Akhmet D.D.1, Baimakhanov Zh.B.2, Nurlanbayev E.K.2, Matkerimov A.Zh.2, Chormanov A.T.2, Baimakhanov B.B.2
'NC JSC «S.D. Asfendiyarov Kazakh National Medical University», Almaty, Kazakhstan 2JSC «A.N. Syzganov National Scientific Center for Surgery», Almaty, Kazakhstan
Abstract
Purpose of the study. Conduct a retrospective comparative analysis of the results of laparoscopic and traditional methods of inguinal hernia repair, patients treated at the surgical department of "A.N. Syzganov National Scientific Center of Surgery", Almaty, Kazakhstan.
Materials and methods. In the period from January 2017 to December 2020, 137 patients were operated at the "A.N. Syzganov National Scientific Center of Surgery" in a planned manner for inguinal hernia and all patients were divided into 2 main groups: operated by traditional methods and laparoscopic method.
Results. The data of the analysis suggests that the laparoscopic method of hernioplasty has an advantage over the traditional methods.
Conclusion. Based on a comparative analysis of the indicators of patients in both groups, it can be concluded that the duration of the operation for laparoscopic hernia repair is 92.3 minutes, significantly more than with traditional methods, which is 79.4 minutes.
Despite this, the duration of analgesic therapy in the postoperative period with laparoscopic hernia repair is 2.4 days, and the duration of hospital stay after surgery is 3 days, much less than with traditional methods, in which the duration of analgesic therapy in the postoperative period is 3, 3 days, and the duration of hospital stay after surgery is 4.6 days. This analysis suggests that laparoscopic hernioplasty has an advantage over traditional methods.
https://doi.org/10.35805/BSK2021IV027
Akhmet D.D.
orcid.org/0000-0002-6942-9855
Baimakhanov Zh.B.
orcid.org/0000-0002-2682-5591
Nurlanbayev E.K.
orcid.org/0000-0001-8758-5061
Matkerimov A.Zh.
orcid.org/0000-0001-8492-2958
Chormanov A.T.
orcid.org/0000-0003-3513-1935
Baimakhanov B.B.
orcid.org/0000-0003-0049-5886
Corresponding author: Akhmet D.D. - resident physician, NC JSC "S.D. Asfendiyarov Kazakh National Medical University", Almaty, Kazakhstan
E-mail:diyar. akhmet@mail.ru
Conflict of interest
The authors declare that they have no conflicts of interest
Keywords
inguinal hernia, laparoscopic hernioplasty, traditional methods of hernioplasty
Лапароскопиялык жэне дэстYрлi шап жарыгыньщ пластикасы нэтижелерш салыстырмалы талдау
Ахмет Д.Д.1, Баймаханов Ж.Б.2, Нурланбаев Е.К.2, Маткеримов А.Ж.2, Чорманов А.Т.2, Баймаханов Б.Б.2
1«С.Д. Асфендияров атында?ы Казак, Улттык, медицина университет^ АК,, Алматы к,., Казахстан 2«А.Н. Сыз?анов атында?ы Улттык, ?ылыми хирургия орталы^ы» АК, Алматы к., Казахстан
Ацдатпа
Материал жэне эдстер. 2017жылгы кацтардан 2020 жылты желтоксан айына дейiн А.Н.СызЕанов атындаЕы Улттык гылыми хирургия орталь^ында 137 наукаска жоспарлы гурде шап жарыЕы бойынша ота жасалды. Барлык наукастар непзп 2 топка бвлнд - дeстYрлi жэне лапароскопиялык э^спен ота жасал€андар.
Нэтижелер. Талдау деректерi герниопластиканыц лапароскопиялык эдiсiнiц дэстYрлi эд^не кара€анда артыкшылы€ыныц болуына квз жетзеМ
Цорытынды. Ек топтагы наукастардыц кврсеткiштерiн салыстырмалы талдау непзнде лапароскопиялык гер-ниопластика бойынша операцияныц узакты^ы 92,3 минутты курайды, бул дэс^Yрлi эдiстермен салыстыртанда айтарлыктай узагырак,, я€ни 79,4 минут.
Осыпан карамастан, лапароскопиялык герниопластика бойынша операциядан кейiнп кезецде анальгетикалык терапияныц узакты^ы 2,4 ^нщ, ал операциядан кейiн ауруханада болу узакты^ы 3 кYндi курайды, бул дэстYрлi э^стермен салыстыртанда элдекайда аз, операциядан кейнп кезецде анальгетикалык терапия узакгыты, кезец 3, 3 к/н, ал операциядан кейiн ауруханада болу узакгыгы 4,6 к/н болды. Бул талдау лапароскопиялык герниопластиканыц дэстYрлi эдстерден артыкшылыты бар еке^н кврсетедi.
Хат алысатын автор: Ахмет Д.Д. - дэркер-резидент, «С.Ж. Асфендияров атындары Казак, Улттыц медицина университет» Ке АК,, Алматы к., Казахстан. E-mail: diyar.akhmet@mail.ru
Мудделер кактыгысы
Авторлар мудделер какгыгысынын, жокгыгын мeлiмдейдi
Туйш сездер
шап жарыеы, лапароскопиялык, герниопластика, герниопластиканын дэ^рл! эдiстерi
Сравнительный анализ результатов пластики паховых грыж лапароскопического и традиционных методов
Автор для корреспонденции: АхметД.Д. - врач-резидент, НАО«Казахский Национальный медицинский университет имени С.Д. Асфендиярова», г. Алматы, Казахстан. E-mail: diyar.akhmet@mail.ru
Конфликт интересов
Авторы заявляют об отсутствии конфликта интересов
Ключевые с лова
Паховая грыжа, лапароскопическая герниопластика, традиционные методы герниопластики
Ахмет Д.Д.1, Баймаханов Ж.Б.2, Нурланбаев Е.К.2, Маткеримов А.Ж.2, Чорманов А.Т.2, Баймаханов Б.Б.2
НАО «Казахский Национальный медицинский университет им. С.Д. Асфендиярова», г. Алматы, Казахстан АО «Национальный научный центр хирургии им. А.Н. Сызганова», г. Алматы, Казахстан
Аннотация
Цель исследования - провести ретроспективный сравнительный анализ результатов лапароскопических и традиционных методов пластики паховых грыж у пациентов, пролеченных в хирургических отделениях Национального научного центра хирургии имени А.Н. Сызганова, Алматы, Казахстан.
Материалы и методы. В период с января 2017г. по декабрь 2020г. в «ННЦХим. А.Н. Сызганова» 137 пациентов прооперированы в плановом порядке по поводу паховой грыжи, и все пациенты были разделены на 2 основные группы: прооперированных традиционными методами и лапароскопическим методом.
Результаты. Данные анализа позволяют предположить, что лапароскопический метод герниопластики имеет преимущество над традиционными методами.
Выводы. На основании сравнительного анализа показателей пациентов обеих групп можно сделать вывод, что продолжительность операции по лапароскопическойгерниопластике составляет 92,3 минуты, что значительно больше, чем при традиционных методах, составляющих 79,4 минуты.
Несмотря на это, продолжительность анальгетической терапии в послеоперационном периоде при лапароскопической герниопластике составляет 2,4 дня, а продолжительность пребывания в стационаре после операции - 3 дня, что намного меньше, чем при традиционных методах, при которых продолжительность аналь-гетической терапии в послеоперационном периоде составляет 3, 3 дня, а продолжительность пребывания в стационаре после операции - 4,6 дня. Этот анализ показывает, что лапароскопическая герниопластика имеет преимущество перед традиционными методами.
Relevance
A hernia is a congenital or acquired defect in the muscular-aponeurotic integrity of the abdominal wall, which makes it possible for any formation to protrude through it, which does not occur here under normal conditions [1]. Inguinal hernia is the most common type of hernia (about 70% of the total) [2]. An inguinal hernia is a type of hernia of the anterior abdominal wall, in which the hernial sac is in the inguinal canal [3]. The main criterion for a hernia is the presence of a defect in the abdominal wall in the region of the inguinal canal. In this case, the presence of a hernial sac is not necessary, although usually the components of a hernia are: a hernial gate, a hernial sac, the contents of a hernial sac. The contents of the hernial sac can be represented by any organ of the abdominal cavity, but most often - by a strand of the greater omentum or a loop of the small intestine. An inguinal hernia can be unilateral: left- or right-sided, or it can have bilateral localization. Inguinal hernias are congenital and acquired, oblique and straight. Congenital inguinal hernia is always oblique and is formed only as a result of non-closure of the vaginal process of the peritoneum. The emergence of acquired oblique and straight inguinal hernias is largely due to the
anatomical weakness of the anterior and posterior walls of the inguinal canal [6, 8]. A hernia is not classified depending on the size of the hernial protrusion or the size of the hernial orifice, but may be accompanied by the presence or absence of the hernial sac descending into the scrotum. The contents of the hernial sac may or may not be adjusted into the abdominal cavity, hence the division of inguinal hernias into reducible and nonreducible hernias. An inguinal hernia is diagnosed annually: in Kazakhstan - 30,000 patients; in the Russian Federation - 220,000 patients; in the USA -500,000 - 700,000 patients; in Germany - 180,000 patients [4]. Operations for inguinal hernias rank first in terms of frequency among elective surgical interventions [7]. Every year in the world about 20 million operations to remove inguinal hernias are performed [5]. Relapses in practical surgery occur after traditional methods of hernioplasty in 2-20%, and recurrences in 35-40% of patients, while after prosthetic techniques, relapse averages 1-5% [9, 10, 11]. There is a wide selection of plastic of the inguinal canal, and all these methods can be divided into 2 groups: traditional and laparoscopic. The question of the advantages of one or another plastic method remains relevant.
Purpose of the study
Conduct a retrospective comparative analysis of the results of laparoscopic and traditional methods of inguinal hernia repair, patients treated at the surgical departments at A.N. Syzganov National Scientific Center for Surgery, Almaty, Kazakhstan.
Materials and methods
In the period from January 2017 to December 2020 in A.N. Syzganov NSCS 137 patients were operated in a planned manner for inguinal hernia.
As presented, all patients were divided into 2 main groups: Group 1 - 83 patients operated on by traditional methods of hernia repair; Group 2 - 54 patients operated on by the laparoscopic method (Fig. 1.).
The average age of patients in group 1 is 59.6 years (max = 88, min = 17); The average age of patients in group 2 is 50.9 years (max = 81, min = 19);
In both groups, hernia repair methods were performed using the «Ultra PRO» synthetic mesh made of monocryl-prolene composite material.
The choice of tactics of surgical treatment was largely determined by the presence of concomitant
Figure 1.
The main groups of patients presented in the comparative analysis.
h Laparotomy ■ L aparoscopy pathology in the anamnesis and the size of the hernial protrusion.
Results
Conducting a comparative analysis of the data of 137 patients operated in a planned manner since January 2017 to December 2020 about an inguinal hernia at A.N. Syzganov NSCS «between the two groups in terms of: gender ratio; localization of inguinal hernia: right-sided, left-sided and bilateral; the size of the hernial protrusion; the size of the hernia gate; the presence of lowering of the hernial sac into the scrotum - no statistical difference was found (p = ns) (Table 1).
Laparotomy N = 83
Laparoscopy N = 54
Deviation
ns
ns
ns
ns
ns
14
6
ns
Table 1.
Patient indices without a statistically significant difference (p = ns)
Laparotomy N = 83
Laparoscopy
.. Deviation
N = 54
P<0.05
P < 0.05
P < 0.05
P < 0.05
P < 0.05
P < 0.05
4,6(16/1)
3(6/1)
P < 0.05
Table 2. Indicators of patients with the revealed statistical difference (p <0.05)
ns
P < 0.05
Number of patients
Right-sided localization
Left-sided localization
Bilateral localization
Time since last surgery (months)
Hernia size (sm)
Sizes of the hernia gate (sm)
Lowering the hernial sac into the scrotum
Number of patients Age (years)
Concomitant pathology Reversibility of the hernia into the abdominal cavity The presence of previous surgical interventions in the abdominal cavity Hernia recurrence
Plastic with synthetic mesh "Ultra PRO" Duration of surgery (min) Duration of analgesic therapy in the postoperative period Duration of stay after surgery
Figure 2.
Diagram of comparative analysis of the indicator of the duration of the operation of 2 groups
Figure 3.
Diagram of comparative analysis of the duration of analgesic therapy after surgery for 2 groups
Figure 4.
Diagram of comparative analysis of the indicator of the duration of the patient's stay in the hospital after surgery for 2 groups
According to the index of reducibility of the hernial protrusion into the abdominal cavity in patients of group 1, out of 83 patients, in 65 the hernial protrusion was reduced into the abdominal cavity, in 18 patients there was the inappropriateness of the hernial protrusion. In patients of group 2, out of 54 patients, in 51 patients, the hernial protrusion was reduced into the abdominal cavity, in 3 patients there was an inappropriateness, which indicates the presence of a statistical difference (p <0.05) (Table 2).
Out of 83 patients in group 1, 37 had previous surgical interventions in the abdominal cavity; in patients of group 2, 12 of 54 patients had previous surgical interventions in the abdominal cavity, which indicates the presence of a statistical difference (p <0.05) (Table 2).
Hernia recurrence in patients of group 1 was observed in 25 out of 83 patients; in group 2, hernia recurrence was observed in 4 out of 54 patients, which indicates the presence of a statistical difference (p <0.05) (Table 2). Hernia repair using a synthetic mesh «Ultra PRO» made of composite material monocryl-prolene, in patients of group 1 -out of 83, 21 patients were performed; that regarding group 2, mesh hernia repair was performed in all 54 patients, which indicates the presence of a statistical difference (p <0.05) (Table 2).
The average duration of the operation (minutes) in patients of group 1 is 79.2, the longest operation lasted 195 minutes, the least lasting 30 minutes. In patients of group 2, the average duration of the operation was 92.3 minutes, the longest operation lasted 160 minutes, the least lasting 30 minutes, which indicates the presence of a statistical difference (p <0.05) (Fig. 2).
Analgesic therapy in the postoperative period in patients of group 1 was carried out on average for 3.3 days. The most prolonged analgesics were prescribed within 8 days, the least long - within 1 day. In group 2 patients, analgesic therapy was carried out on average for 2.4 days. The most prolonged analgesics were prescribed within 5 days, the least long - within 1 day, which indicates the presence of a statistical difference (p <0.05) (Fig. 3).
With regard to the length of stay of the patient in the hospital after the operation, the patients of group 1- needed to be in the hospital for an average of 4.6 days. The longest patients stayed in the hospital after surgery for 16 days, the least long for 1 day; Patients in group 2 - needed to be in the hospital for an average of 3 days. The longest patients stayed in the hospital after surgery for 6 days, the least long for 1 day, which indicates the presence of a statistical difference (p <0.05) (Fig. 4).
During the observation period, postoperative complications were not observed in any group.
Conclusion
Based on a comparative analysis of the indicators of patients in both groups, it can be concluded that the duration of the operation for laparoscopic hernia repair is 92.3 minutes, significantly more than with traditional methods, which is 79.4 minutes (Fig. 2).
Despite this, the duration of analgesic therapy in the postoperative period with laparoscopic hernia
References
repair is 2.4 days, and the duration of hospital stay after surgery is 3 days, much less than with traditional methods, in which the duration of analgesic therapy in the postoperative period is 3, 3 days, and the duration of hospital stay after surgery is 4.6 days. (Fig. 3, 4). This analysis suggests that laparoscopic hernioplasty has an advantage over traditional methods.
1. Tension-free hernioplasty / Under total. ed. V.N. Egieva. - M.: Medpraktika - 2002 .-148 p.
2. "European Hernia Society's Guidelines for the Management of Inguinal Hernias in Adult Patients", Hernia Journal, 2009.
3. Shalashov S.V., Kulikov O.K. Inguinal hernia in adults: A guide for physicians /Novosibirsk: Nauka, 2011. -136 p.
4. Protasov A.V. [et al]. Features of classifications of hernias in modern surgery (literature review) // Endoscopic surgery. -2007. - No. 4. - P. 49-52.
5. Greyasov V.l., Chuguevsky V.M., Ivanov S.A. Modern methods of treatment of hernias of the anterior abdominal wall [Text]: Almanac of the Institute of Surgery.2015-S. 27-35.
6. Zhebrovsky V.V., Elbashir M.T. Surgery of abdominal hernias and eventrations / Simferopol, 2002. -438 p.
7. Plastic surgery of the inguinal canal according to Liechtenstein and its modifications / D.V. Chizhov [and others] // Herniology. - 2004. - No. 1. - P. 43-51.
8. Yoffe I.L. Surgical treatment of inguinal hernias / -Moscow: Medicine, 1968 .- 172 p.
9. Egiev V. N. Tension-free hernioplasty. - M .: Medpraktika, 2002 .-148 p.
10. Chizhov D.V. [and others]. Plastics of the inguinal canal according to Liechtenstein and its modifications // Herniology. - 2004. - No. 1. - P. 43-51.
11. Protasov A.V. [et al.]. Features of classifications of hernias in modern surgery (literature review) // Endoscopic surgery. - 2007. - No. 4. - P. 49-52.
