OBJECTIVE
To substantiate on the basis of clinical and anatomical studies the clinical and topographic-anatomical criteria of choosing the rational technique of endovideosurgical hernioplasty in patients with inguinal hernias, allowing to minimize the postoperative complications and the probability of the disease recurrence.
MATERIAL AND METHODS
Applied topographic-anatomical study was performed using cadaveric material (11 objects) and based on the analysis of 17 histotopograms of plastinated transverse cuts of the anterior abdominal wall (from the ureteric process to the bosom articulation) performed on three anatomical objects. The clinical studies were based on the treatment experience of 1006 patients operated on using the technique of total extraperitoneal inguinal hernia repair (TEP), divided into retrospective (n=329) and prospective (n=677) groups.
RESULTS
The preperitoneal fascia was found to be visualized during the study in all 11 cadavers. Its thickness differed in different regions of the anterior abdominal wall. The technical possibility to perform endoscopic hernioplasty according to the TER technique is available in patients of all types of physique. The TEP access to the interfascial preperitoneal cellular space developed from the topographic-anatomical positions allows to exclude the risk of damaging the peritoneum, epigastric vessels and nerves in the “pain triangle” and to reliably install the mesh prosthesis without stapler fixation. The conversion rate in the prospective study was 1.2%, which was significantly lower than in the retrospective study (9.1%), the rate of postoperative complications in the prospective study was 1%, which was significantly lower than in the retrospective study (3.9%).
CONCLUSION
The peculiarity of the structure of the anterior abdominal wall in the hypogastric region is the presence of the interfascial preperitoneal cellular space (between the transverse and preperitoneal fascia), predisposing to safe placement of the mesh prosthesis by endovideosurgical access. The preperitoneal fascia is an important landmark in the interperitoneal fascial space, which is a bed for placing the implant in the “correct” layer.
