Modified technique of open inguinal hernioalloplasty and its effect on surgical outcomes, as well as preservation of reproductive function

Background. According to the World Health Organization, herniated diseases of the anterior abdominal wall, including inguinal hernias, remain one of the most common causes of elective surgery worldwide, accounting for up to 20 % of all general surgery operations. The purpose of this study is to increase the effectiveness of surgical treatment of patients with complicated forms of inguinal hernias by improving the technical aspects of open hernioplasty. Materials and methods. One hundred and twenty-four patients with inguinal hernias were selected for a prospective observational study. The first group, the comparison one, consisted of 46.0 % of participants operated by the Lichtenstein method, the second group, the main one, included 54.0 % of patients who underwent modified open tension-free inguinal hernioplasty. Results. In the main group, the overall rate of wound complications was 6.0 %, while in the comparison group, this indicator reached 21.2 %. The recurrence rate of inguinal hernia decreased from 4.9 to 0.0 %. In the comparison group, testicular atrophy was observed in 3 cases (7.3 %), and in 4 cases (9.8 %) — impaired reproductive function. These data indicate a significantly lower risk of complications after the use of the modified inguinal hernioalloplasty method. Conclusions. Modified open tension-free inguinal hernioplasty using a hernial sac flap to cover a mesh implant demonstrated high clinical efficacy in reducing the frequency of postoperative seromas to 1.5 % in the main group versus 8.8 % with the classical Lichtenstein technique. The formation of a biological barrier between the implant and the structures of the spermatic cord significantly reduces the risk of fibrotic scarring, minimizes the likelihood of compression of the vascular-spermatic bundle, which, in turn, ensures the preservation of reproductive function in men (with a decrease in complications from 17.1 to 0 %) and contributes to a more favorable course of the early postoperative period.

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