OBJECTIVE
Analysis of intraoperative and early postoperative results of the use of intracorporeal integral suture during laparoscopic hernioplasty of direct inguinal hernias.
MATERIAL AND METHODS
A prospective single-center study was conducted on the basis of the City Clinical Hospital named after. S.S. Yudin in Moscow. The study included 102 patients with newly diagnosed direct inguinal hernias, who were divided into a comparison group (n=51, 50%) with the use of an integral suture and a control group (n=51, 50%) without hernial defect suturing. eTEP (extended Total Extraperitoneal Plasty) hernioplasty with ipsilateral access was performed in two groups.
RESULTS
The average duration of operations was 47.25±8.68 minutes in the first group and 43.63± 8.31 minutes in the control group. The size of the hernia defect varied from 1.5 cm to 3 cm. The degree of pain was assessed using a validated visual analog scale (VAS) on the 2nd day after surgery and amounted to 2.57±1.09 in the comparison group and 2.9± 1.29 in the control group, which is minimal/moderate pain in two groups. The average length of hospitalization was 3.89±1.64 days. On the first day after surgery, ultrasound results revealed seromas in 6 patients (11.7%) above the pubic bone in the suturing group and in 22 patients (43.1%) in the dead space of a rectus inguinal hernia formed by stretching the transverse fascia by intra-abdominal pressure (p=0.05). Intraoperative complications in the form of bleeding and damage to non-target structures were absent in two groups.
CONCLUSION
This work is the first to clearly demonstrate the technique of endoscopic closure of a hernia defect of a direct inguinal hernia with an anatomical justification. The advantage of the technique is associated with the prevention of seromas in the postoperative period without severe pain syndrome. The corrected disadvantage is a increasing of the duration of the operation by an average of 3.62 minutes (95% CI 0.23—7.01, p<0.05). To more accurately assess long-term results and determine indications for the use of integral suture in herniology, further randomized clinical studies are needed.
