POSTOPERATIVE PERIOD AFTER OPEN AND LAPAROSCOPIC ALLOGHERNIOPLASTY OF INGUINAL HERNIA IN ELDERLY AND OLDER AGE PEOPLE
DOI:
https://doi.org/10.11603/2414-4533.2025.1.15177Keywords:
inguinal hernia, TAPP, Lichtenstein, perioperative period, elderly and senile personsAbstract
The aim of the work: to evaluate the effectiveness and compare the results of the postoperative period after performing open and laparoscopic allohernioplasty of inguinal hernias in senile and elderly patients.
Materials and Methods. The study included 96 patients with primary inguinal hernias (K40 according to ICD-10). The first group consisted of 39 patients who underwent laparoscopic transabdominal preperitoneal repair (TAPP) using fixation and non-fixation methods. The average age of the patients in this group was (68.3±5.78) years. Two types of mesh implants were used in this group of patients: 28 (71.79 %) patients used polypropylene meshes measuring 6×11 cm with fixation by 3–5 tackers; 11 (28.21 %) patients used polypropylene meshes with a nitinol frame. The method of anesthesia was inhalation anesthesia, artificial ventilation in all patients. The second group – 57 patients who underwent open allohernioplasty (Lichtenstein method). The average age of the patients was (66.8±6.91) years. A polypropylene mesh measuring 6×11 cm was used to close the hernial defect. The method of anesthesia – local anesthesia (longocaine solution 2.5 mg/ml) – 12 (21.05 %) patients, spinal anesthesia – 21 (36.84 %) patients, general anesthesia without intubation – 24 (42.10 %) patients.
Results. When performing laparoscopic allohernioplasty, bleeding from the abdominal wall was observed in 2 (5.1 %) patients (1 – during trocar placement, 1 – during hernia sac release). In 2 (5.1 %) patients, seroma developed, which disappeared on its own within a month. Chronic pain and paresthesia were present in only 1 (2.56 %) patient, which disappeared within 2 months. Analyzing open methods of hernioplasty, the duration of this operation was practically the same as in laparoscopic ((42.56±12.45) min versus (47.81±14.87) min). In 10 (17.5 %) patients, pronounced postoperative pain and paresthesia were noted, which did not disappear up to 6 months. In 4 (7 %) patients, seromas developed, which disappeared on their own within a month, in 1 (1.75%) case there was suppuration of the postoperative scar. In 2 (3.5 %) patients, postoperative edema of the scrotum appeared on the side of hernioplasty.
Conclusions. When comparing two randomized groups of patients who underwent laparoscopic and open surgery for primary inguinal hernias, the advantages of laparoscopic surgery were still revealed: almost two times lower complication rate, more than twice the average duration of inpatient treatment, and reduced intensity of early and long-term postoperative pain.
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