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IV. СЛУЧАИ ИЗ ПРАКТИКИ
UDC 616-089;617.5
About the authors:
Zarraf T. Shirinov - head of the department of surgery of liver, biliary tract and pancreas of the SCS n/a M.A.Topchibashev, dr.
med.;
Namized H. Khankishiyev -dissertator, Shirvan Central Hospital
Faradzhullah S. Idrisov - junior researcher of the department of surgery of liver, biliary tract and pancreas of the SCS n/a M.A.Topchibashev, can. med.
Key words:
inguinal hernia, auto-hernioplasty, post-operational consequences.
THE RESULTS OF CLINICAL OBSERVATIONS OF AUTO-HERNIOPLASTY FOR PATIENTS WITH INGUINAL HERNIA
Shirinov Z.T., Khankishiyev N.H., Idrisov F.S.
Scientific Center of Surgery named after M.A. Topchibashev, Shirvan Central Hospital, Baku, Azerbaijan
Abstract
The results of clinical observations of auto-hernioplasty for 200 patients with inguinal hernia are studied by The Scientific Centre of Surgery named after M.A. Topchubashev and Shirvan Central Clinical Hospital. Operations for patients: repair for Gerard-Spasokukotsky-Kimbarovsky - 64 patients 32%; Martynov - 34 patients 17%; Bassini - 26 patients 13%; Shouldice -18 patients 9%; Postempski - 58 patients 29 %. Intra-operational, early and long-time post-operational consequences are studied and compared.
Шaп œapbifbrna ^тыны oтa жacaлfaн aypyлapfa ayтoгepниoплacтикaны ^лдэнудыщ нэтижeлepiн бafaлay
Aвтopлap тypaлы:
Шиpинoв Çappaô Taxмaз ombi - M.A. Toпчибaшeв anrn. fXO бayыp, вт жoлдapы жэнe ±йкы бeзi xиpypгияcы бвлiмшeciнiœ мeцгepyшici, м.г.д.; Xaнкишиeв Haмизeд Гaнифe -диccepтaнт, ОКБ, Шиpвaн к. Идиpиcoв Фapaджyллax Ca-дyллax oглы - M.A. Toпчибaшeв aтындaFы fXO бayыp, вт жoл-дapы жэнe ±йкы бeзi xиpypги-яcы бвлiмшeciнiц úwi рылыми кызмeткepi.
Тушн ceздep:
шaп жapыFы, ayтoгepниoплa-cn^a, oпepaциядaн кeйiнгi нэтижeлep.
Ширинов З.Т., Ханкишиев Н.Г., Идрисов Ф.С.
М.А. Топчибашев атындаш Рылыми хирургия орталыш, Ширван Орталык, клиникалык, ауруханасы, Баку, Эз1рбайжан.
Ацдатпа.
Шап жарыгымен 200 пациентке аутогерниопластика жасалган клиникалык кддагалау нэтижелер1 М.А. Топчибашев атындагы Рылыми хирургия орталыгында зерделендi. Келес пациенттерге жасалган операциялар зерделенд'и Жерар-Спасокукоцкий-Кимбаровски бойынша - репарация 64 пациентт'щ -32%; Мартынов эдс бойынша - 34 пациентт'щ -17%; Бассини бойынша - 26 пациентт'щ 13%; Шоулдис бойынша - 18 пациентт'щ - 9%; Постемпски бойынша - 58 пациентт'щ - 29%. Интраоперативл, ерте жэне ±зак мерзiмдi калдык эсерлерi зерделе^п, оларга салыстырма жасалган.
Об aвтopax:
Шиpинoв Зappaф Taxмaз oглы - зaвeдyющий oтдeлeниeм xи-pypгии пeчeни, жeлчныx пyтeй и пoджeлyдoчнoй жeлeзы HL¡X им. M.A. Toпчибaшeгo, д.м.н., e-mail: [email protected]; Xaнкишиeв Haмизeд Гaнифe oглы - диccepтaнт, ЦКБ г.
Шиpвaн;
Идpиcoв Фapaджyллax Caдyл-лax oглы - мл. нayч. coтpyдник oтдeлeния xиpypгии пeчeни, жeлчныx пyтeй и пoджeлyдoчнoй жeлeзы HЦ^ им. M.A. Toпчибa-wern, к.м.н.
Kлючeвыe cлoвa:
пaxoвaя ^ыш, ayтoгepниo-плacтикa, пocлeoпepaциoнныe peзyльтaты.
О^н^ peзyльтaтoв пpимeнeния ayтoгepниoплacтики бoльным oпepиpoвaнныx пo пoвoдy пaxoвыx фыж
Ширинов З.Т., Ханкишиев Н.Г., Идрисов Ф.С.
Научный Центр Хирургии имени М.А. Топчибашева, Ширванская Центральная клиническая больница, Баку, Азербайджан. ([email protected])
Аннотация
Результаты клинических наблюдений аутогерниопластики у 200 пациентов с паховой грыжей изучались Научным центром хирургии имени А. Топчубашева и Ширванской Центральной клинической больницей. Операции у пациентов: репарация для Жерара-Спасокукоцкого-Кимбаровски - 64 пациента 32%; Мартынов - 34 пациента 17%; Бассини - 26 пациентов 13%; Шоулдис -18 пациентов 9%; Постемпски - 58 пациентов 29%. Интраоперативые, ранние и долгосрочные послеоперационные последствия изучались и сравнивались.
Introduction:
In the world abdominal wall hernias are found in about 7% of the population, among people of middle and old age, the figure is 15-17%. Among the 70% of hernias account for inguinal hernias [1,2]. For the year in Russian Federation 200,000 and in the US 700,000 herniaplastic surgery for inguinal hernia are carried out, that are spent $ 30 billion [3, 4]. Each year worldwide 20 million people are at herniaplastic surgery, and this in turn makes 10-15% of all operations [5].
In postoperative period, the most common are reherniations. In average it is found in 1-15% of patients. In patients with middle and old age relapses occur more frequently - at 8-30%. 80-90% relapse formed in a year after the operation, and 10-20% in subsequent years. [6] After repeated operations, the risk of recurrence rises to 30-35% [7,8,9].
Materials and Methods:
The results of clinical observations of auto-herniaplastics in 200 patients operated for inguinal hernias in the Scientific Center of Surgery named after academician M.A. Topchibashov and Shirvan Central clinical hospital. The median age was 52 years among patients from 16 to 82 years. 190 patients (95%) were men, and 10 patients (5%) were women. As you can see, men are more prone to disease of inguinal hernia than women, that is a ratio of 20: 1. The average age of patients was 50 years, and this in turn confirms that the inguinal hernia occurs in the working-age population and creates social problems. In this regard, in the United States and the European Union there are societies of herniologiests and clinics, which are based only on the conduct of the inguinal operations.
From anamnesis incidence of hernias until 3 years in 55% of patients, 34% from 3 to 5 years, and 11% of patients over 5 years. Most patients with this disorder carry bandage more than 5 years, and this in turn leads to hyperpigmentation of skin at the groin and sometimes even to skin maceration. According to literature and our data carrying bandage is possible only in the case if the age of the patient and the hemodynamic parameters did not allow the operation.
Clinically, patients with such complaints have been observed as swelling in the area of hernia or in the scrotum, pain during exercise, reduced physical and sometimes sexual activity, the presence of discomfort, presence of recurrence, as well as wearing a bandage in some patients.
22 patients (11%) were admitted to the clinic urgently, and 178 patients (89%) in a planned
manner. Patients with strangulated hernia, an emergency basis, the surgeon after a physical examination, putting the general analysis of blood, urine, stool, chest X-ray, ECG, ultrasound, blood type, Rh, RW, AIDS and syphilis, HBs and HCv Ag in the blood for 2 hours undergo surgery.
Patients hospitalized in the clinic routinely, passed outpatient or inpatient examination standard protocol-abdominal ultrasound (required examination of the prostate gland after 50 years), sometimes CT scan or MRI. Due to the associated diseases patients passed examination and consultation with other specialists.
As a result of surveys conducted in 81 patients (40.5%) there were found associated diseases (hypertension, ischemic heart disease - atherosclerotic cardiosclerosis, HH reflux esophagitis, prostate adenoma, chronic pyelonephritis, chronic calculous cholecystitis, chronic bronchitis and duodenal ulcer).
After conducting surveys to appropriate patient refined diagnosis and compiled before the algorithm determines the type of operation and type of anesthesia, the patient receives detailed information about complications of surgery and gives written consent to the operation.
Variety of auto-herniaplastic operations: 98 patients (49%) held by plastics operation of the front wall of the inguinal canal, 64 patients (32%) carried out by the method of plastic of Gerard-Spasokukotsky-Kimbarovsky, 34 (17%) by the Martynov method. For 102 patients (51%) there was chosen as a method of strengthening the posterior wall of the inguinal canal. 26 (13%) of these patients had the Bassini surgery method, 18 patients (9%) - by the method of Shouldice, 36 (18%) by the method Postempski and 22 patients (11%) by our modification of the Postempski method.
Discussion:
The results of complications in patients during surgery and after primary auto-herniaplastic surgery, have been studied and analyzed comparatively.
Complications during surgery were reflected in the table №1. As can be seen from the table, in 29 patients (14.5%) of 200 patients in this group there were observed complications during surgery. Least of all complications were observed in 3 patients (5.3%) operated by the method of Martynov. In second place 13.8% 8 patients operated by the method Postempski. In the remaining three groups of patients experiencing similar results. Approximately among 15-17% there were no significant changes.
Table 1.
Complications during the operations
№ Operations: Complications:
n % subcutaneous bleeding and bruises Slash and compression n. ilioinguinalis Deserosation of intestinal wall Damage of the femoral vein while sewing CO о 1—
1 Gerard-Spasokukotsky-Kimbarovsky method 64 32 5 (7,8%) 3 (4,7%) 2 (3,1%) 1 (1,6%) 11 17,2%
2 Martynov method 34 17 2 (5,9%) 1 (2,9%) - - 3 5,9%
3 Bassini method 26 13 2 (7,7%) 1 (3,8%) 1 (3,8%) - 4 15,5%
4 Shouldice method 18 9 1 (5,6%) 1 (5,6%) 1 (5,6%) - 3 16,8%
5 Postempski method 58 27 3 (5,2%) 4 (6,9%) 1 (1,7%) - 8 13,8%
Total: 200 100 13 (6,5%) 10 (5%) 5 (2,5%) 1 (0,5%) 29 14,5%
The most common complications are bleeding and subcutaneous hematoma in 13 patients 6.5%, cutting and compression n. ilioinguinalis in 10 patients 5%, desarisation of intestinal wall of small
bowel and colon in 5 patients 2.5%. Only one patient (0.5%) showed of the femoral vein damage during suturing wounds. The results are reflected in the diagram №1.
Diagram №1.
Complications during the operations
Received and studied, the primary complications in patients after auto-herniaplastic surgery are presented in Table №2.
Table 2.
The primary complications after surgery
№ Operations: Complications:
n % subcutaneous bleeding and bruises Slash and compression n. ilioinguinalis Deserosation of intestinal wall Damage of the femoral vein while sewing CO о 1—
1 Gerard-Spasokukotsky-Kimbarovsky method 64 32 7 (10,9%) 5 (7,8%) 4 (6,3%) 3 (4,7%) 19 29,7%
2 Martynov method 34 17 2 (5,9%) 1 (2,9%) 2 (5,9%) - 5 14,7%
3 Bassini method 26 13 2 (7,7%) 2 (7,7%) 1 (3,8%) 2 (7,7%) 7 26,9%
4 Shouldice method 18 9 2 (11,2%) 1 (5,6%) 1 (5,6%) 1 (5,6%) 5 26,9%
5 Postempski method 58 27 3 (5,2%) 4 (6,9%) 4 (6,9%) 2 (3,4%) 13 22,4%
Total: 200 100 16 (8%) 11
(5,5%) 8 (4%) 8 (4%) 43 21,5%
As seen from Table №2, at the primary level after surgery in 43 patients (21.5%) of the total 200 patients there were found various complications. The most common complications were subcutaneous infiltration, seroma, wound abscess were observed in 16 patients (8%), pain in 11 (5.5%), indicators of stagnation in the scrotum and orchitis were equal and occurred in 8 patients (4%). By comparing the results of different methods, most complications
were observed in 5 patients (14.7%), operated by the method of Martynov. In second place were complications in 13 patients (22.4%), by method of Postempski. Indicators of patients operated by the method of Bassini and Shouldice were equal and amounted to 26.9%. A performance of patients operated by the method of Gerard-Spasokukotsky-Kimbarovsky were negative and amounted to 29.7%. The results are shown in diagram №2.
Diagram №2.
The primary complications after surgery
In 174 patients (87%) during the operation, in which auto-herniaplastics was used, we studied the late results of 1-5 years. In 13% of cases, patients did not respond to the questionnaire sent, and therefore the long-term outcomes of these patients failed to examine. The results were evaluated as "good", "satisfactory" and "unsatisfactory". The results are shown in Table №3.
In order to study the quality of life in patients who underwent surgery for inguinal hernia, we used questionnaire, prepared in 1990 by Professor R.Launois in the Paris laboratory of public health [10].
Results:
Good - 0-3 points is taken into account when: there is no recurrence of complaints of the gastrointestinal tract and the incision after surgery, continued ability to work and older people to engage in simple household chores.
Satisfactory - 4-6 points: the presence of some discomfort due to undergoing surgery in patients without relapses.
Unsatisfactory - > 6 points: the emergence of recurrence, regardless of the presence of complications, more than 6 points.
As the table shows, in 125 patients (71.8%) are excellent and good in 30 patients (17.2%) satisfactory and 19 patients (11%) were obtained bad results.
Oprations Quantity Good 0-3 p. Satisfactory 4-6 p Unsatisfactory > 6 p.
Gerard-Spasokukotsky-Kimbarovsky method 58 37(63,8%) 12(20,7%) 7(5,5%)
Martynov method 30 21(70%) 5(16,7%) 4(13,3%)
Bassini method 23 16(69,6%) 4(17,4%) 3(13%)
Shouldice method 15 10(66,7%) 3(20%) 2(13,3%)
Postempski method 30 23(76,7%) 4(13,3%) 3(10%)
Postempski method in our modification 18 16(88,9%) 2(11,1%) -
Total: 174 125(71,8%) 30(17,2%) 19(11%)
Table 3.
Long term results
When comparing different methods, the best results of auto-herniaplastics were observed in patients operated by Postemski method, 23 (76.7%) operated according to our modified method, in 16 (88.9%) patients, the results vary on a background of 70% and are not too different.
A satisfactory score of auto-herniaplastics the least was observed in patients operated by the method of Postempski - 4 (13.3%) and by our modified method in 2 (11.1%) patients. In second place in 5 (16.7%) and 4 (17.4%) patients by Martynov and Bassini methods respectively. The results of the method of Gerard-Spasokukotsky-Kimbarovsky - 12 (20.7%) and the Shouldice method - 3 (20%) were similar.
An unsatisfactory result is less often observed in patients operated by the method of Gerard-Spasokukotsky-Kimbarovsky - 7 (5.5%), then by the method of Postempski - 3 (10%), after surgery by our modified procedure, there was no recurrence. The results of the other three methods (Martynov, Bassini and Shouldice) were approximately 13% and are not too different.
Conclusions. Based on the obtained results, with oblique inguinal hernia, we suggest auto-herniaplasics by the method Gerard-Spasokukotsky-Kimbarovsky, and with direct inguinal hernia - the Postempski method and our modified method to strengthen the back wall.
References_
1. Egiev V.N., Rudakov M.N., Sergeichev A.K. et al. The results of Liechtenstein to the
disadvantaged plastic inguinal hernias. Endoscope Heer 2006; 3: 3-6. (in Russ.).
2. Timoshin A.D., Yurasov A.V., Shestakov A.L., Fedorov D.A. Modern technique of surgical treatment of inguinal hernias. Methodical recommendations. Moscow. 2003. - 26 p. (in Russ.).
3. Lichtenstein I.L., Amid P.K., Shulman A.G. The iliopubic tract. Is it important in groin herniorrhaphy? Contemp. Surg. 1992. No 4. - p. 22-24
4. Rutkow I.M. Laparoscopic hernia repair. The socioeconomic tyranny of surgical technology. Arch Surg. 1992: 127: 1271
5. Fedorov V.D. Preface. Mat. Int. conference. Moscow. 25-26 November 2003. - p.5-6. (in Russ.).
6. Nesterenko Yu.A., Haziyev R.M., Mudarisov R.R. The results of operations of Shouldice in planned and emergency surgery. Surgery. 2005. №2. - p.49-53. (in Russ.).
7. Novikov K.V. On the question of the treatment of patients with inguinal hernias. Journal of Surgery. - 2001. - №2. - p. 63-66. (in Russ.).
8. Stupin V.Ya., Lantnev V.V., Mikhaylusov S.V., et al. The choice of method of surgical treatment of inguinal hernias. Surgery. - 2009. -№11. - p.53-57. (in Russ.).
9. Langer C., Schaper A., Liersch T., Kulle B., Flosman M., Fbzesi L., Becker H. Prognosis factors in incisional hernia surgery: 25 years of experience. Hernia. March 2005.Vol. 9, Issue 1, -p. 16-21
10. R. Launois Comparative health systems. Adv Health Econ Health Serv Res Suppl. 1990; 1: 179-95.
ВЕСТНИК ХИРУРГИИ КАЗАХСТАНА № 1-2015
