НОВИЙ НАТЯЖНИЙ МЕТОД ОПЕРАЦІЙНОГО ЛІКУВАННЯКОСОЇ ПАХВИННОЇ ГРИЖІ

The aim of the study is to develop a new stretching method of the treatment an oblique inguinal hernia in order to reduce its recurrence and preserve male reproductive function. A series of morphometric studies were conducted on a total of 12 male cadavers, with the age range of 22 to 65 years, on the day after death. In a hospital setting, 34 patients were divided into two groups for operation: 17 patients were treated by the Lichtenstein method (control group), and the same number were treated by the new method offered (main group). The essential features of the offered method of surgical treatment of oblique inguinal hernias include the elimination of the deep inguinal ring, whose functional state and dimensions are directly related to hernia formation; move the spermatic cord under the transverse fascia and transverse abdominal muscle, create a new inguinal ring that is located below the peritoneum of the abdominal cavity, preventing the formation of a hernia sac and hernia; a new inguinal ring that combines the function of both the superficial and deep rings, formed by strong tendon ligaments, the horizontal part of the pubic bone and the musculoaponeurotic flap (the abdominal internal oblique muscle and aponeurosis of the abdominal external oblique muscle) sutured with a Kimbarovsky suture to inguinal ligament. The long-term results were studied by examining the duration of pain syndrome, restoration of blood supply to the testicle, the period of rehabilitation of work capacity and quality of life in the postoperative period. The mathematical calculations of the standard error were determined using Microsoft® Office Excel spreadsheets (build 11.5612.5703) and Statistica v. 6.0 (StatSoft, 2001, USA). The postoperative bed-day in the main group was almost 2 times shorter compared to the control group. Rehabilitation of patients to restoration of working capacity in the main group was 22.2±1.24 days against 26.2±1.38 days in the control group. Recurrence of hernia in the latter group was recorded in 5.5% of patients in the control group, but no recurrences were observed in the main group. Testicular volume on the affected side before surgery was significantly lower in patients of both groups. The results of the study of testicular volume and Dopplergrams indicate testicular ischemia in patients of the control group in the postoperative period, which can be explained by the involvement of the spermatic cord vessels in the postoperative scar and impaired blood flow. The six-month postoperative follow-up period is characterized by an increase in the physical component of health in the control group, but only after 1 year this indicator becomes significantly higher. At the same time, the emotional component of health improves, reaching 66.1 ± 2.08 points just one month after surgery. During the same period after surgery, the physical component of health did not undergo significant changes, while the patient's mental state improved significantly compared to the preoperative period. Six months after the surgery, patients in the main group showed a positive increase in the physical health component indicators, and after 12 months, these indicators were higher than the preoperative levels. Compared to the Lichtenstein method of surgery, the offered technique has significant advantages both in terms of the absence of disease recurrence and in preserving male reproductive function.