COMPARISON OF TRADITIONAL AND LAPAROSCOPIC METHODS OF SURGICAL TREATMENT OF INGUINAL HERNIAS IN BOYS, ACCORDING TO THE CORRELATION ANALYSIS OF STRUCTURAL-FUNCTIONAL STATE OF THE TESTIS

Abstract

Inguinal hernia in children is a frequent pathology requiring surgical intervention. It is known that postoperative complications are 6–6.8 %. Infertility of men is one of the most frequent complications of hernia, including postoperative complications.

The aim of the study – to conduct correlation analysis of indicators of structural-functional state of the testis in laparoscopic and traditional methods of surgical treatment of inguinal hernias in boys.

Materials and Methods. The paper presents clinical and statistical analysis of the results of diagnosis and surgical treatment of 102 boys with inguinal hernia, admitted to the Surgical Department of the Lviv City Children’s Clinical Hospital the period of 2013–2016. The diagnosis of inguinal hernia was established according to statistical classification of disease (ICD-10): inguinal hernia (40). Patients, according to the tasks were divided into 3 groups according to age and into 2 groups depending on surgery. Namely 3 groups according to age: I (n=20) 0 – 6 months, II (n=50) from 6 months – 3 years, III (n=32) – from 3 years and older children. Among them 34 children were operated laparoscopically by the method of PIRS (Percutaneous Internal Ring Suturing) and 68 children – the traditional methods according to Dunelm. By the kind of treatment the patients were divided into subgroups I – were operated laparoscopically, II – operated by traditional method. All the patients were divided into 2 groups according to operative method. Patients of the group 1 (N = 34, average age of 1.5±0.15 years) underwent laparoscopic intervention according to the method of PIRS. In group 2 (N = 68, mean age of 4.5±0.32) we performed surgery in the traditional method Duhamel. Criteria for comparison were the parameters of structural-functional state of the testis by ultrasound examination, elastography, transcutaneous oxner before surgery and in the postoperative period on 1, 14, 30 days and after 6 months of observation.

Results and Discussion. In the younger group of boys, operated according to traditional methods, there was a significant strong inversely proportional correlation between the resistance index, elasticity of the testicular tissue and testicular indicator of oxygenation: r=-0.77 and r=-0.74, respectively, which indicates severe ischemia of the testicular tissue and loss of elasticity on the 7th day after surgical observation. On day 14 of observation is recorded inversely proportional to the average correlation between the resistance index and the index of tissue perfusion in testicular tissue (r=-0.34), which testifies to the increase of ischemia of the testicle with the growth index of vascular resistance. In addition, there is a directly proportional to the average correlation between the elasticity testicle tissue and increased transcutaneous oxner (r=0.45). On the 30th day in the II age group of children, operated according to traditional methods, there is a strong reliable inversely proportional correlation between testis volume and resistance index (r=-0.70, p<0.05).

Conclusions. Inversely proportional to the average correlation we note between elastography image and resistance index, indicating the deterioration of blood flow by reducing the elasticity of the testicular tissue in all age groups.