RESULTS AND COMPLICATIONS AFTER TAPP-PLASTY OF INGUINAL HERNIAS IN ELDERLY AND SENILE PATIENTS

Abstract

The aim of the work: to assess the course and frequency of complications during and after laparoscopic transabdominal preperitoneal plasty of inguinal hernias in elderly and senile patients.

Materials and Methods. A retrospective comparative study of prospectively collected data was conducted on the basis of the Volochysk Multi-Profile Hospital and the Lutsk City Clinical Hospital, which included 56 male patients diagnosed with inguinal hernia (K40 according to ICD-10). The average age of the patients was (69.8±5.8) years, which corresponded to the age categories of elderly and senile age. The patients were divided into two groups depending on the method of mesh implantation: group A (with mesh fixation, n=28) and group B (without fixation, n=28). All patients underwent laparoscopic transabdominal preperitoneal plasty (TAPP). Pneumoperitoneum was created up to 12 mm Hg. 3 trocars were used: one 10-mm (umbilical) and two 5-mm (right and left iliac). All patients were operated on under inhalation anesthesia with artificial ventilation. Pain was assessed using a visual analog scale (VAS) after 2–6 h, the next day, on the day of discharge, after 1 week and 1 month. Chronic pain and paresthesias were assessed using the CPSP (Chronic Post-Surgical Pain) scale in the long term. All patients signed an informed consent to participate in the study and to process personal data for scientific purposes.

Results. The average duration of operations in patients from group A (with mesh fixation) was (64.3±12.5) min, while in group B (without fixation) – (51.4±10.8) min, which is approximately 20 % less than in group A, and is consistent with the data of world researchers, who indicate a reduction in operating time with a fixation-free technique due to the lack of need for additional manipulations with mesh fixation. There were no intraoperative complications during laparoscopic interventions. The total frequency of early and late postoperative complications was recorded in 9 patients: in group A (with mesh fixation) – in 7, in group B (without mesh fixation) – in 2. Pulmonary artery thromboembolism and postoperative pneumonia were not observed in any case. After complete desufflation and control of the correct location of the mesh, the procedure was completed. The ports were sutured with appropriate sutures.

Conclusions. The results of the study showed that TAPP-plasty of inguinal hernias in elderly and senile patients is effective in both fixation and non-fixation methods of mesh implantation. The use of the non-fixation method allowed to significantly reduce the level of postoperative pain and contributed to a faster restoration of functional activity without recurrence.