Mesh fixation methods during open inguinal hernioplasty (Сравнение способов фиксации синтетических имплантатов при паховых герниопластиках передним доступом) тема диссертации и автореферата по ВАК РФ 14.01.17, кандидат наук Мекхаеэль Мекхаеэль Шехата Факхри

• Мекхаеэль Мекхаеэль Шехата Факхри
• кандидат наук
• 2022

Оглавление диссертации кандидат наук Мекхаеэль Мекхаеэль Шехата Факхри

TABLE OF CONTENT

INTRODUCTION

CHAPTER ONE: LITERATURE REVIEW

1.1. History of inguinal hernia surgery

1.2. Using synthetic mesh and mesh 18 types

1.3. Mesh Fixation methods during open inguinal hernia 28 repair

1.4. last year's publications on the topic of 40 dissertation

CHAPTER TWO: MATERIALS AND METHODS

2.1. The general properties of the clinical 47 material

2.2. The specific properties of the clinical 51 material

2.3. Materials and technical support of surgical 56 interventions

2.4. Research methods and 61 investigations

2.5. Methods of statistical 62 analysis

CHAPTER THREE: USING HERNIOSTAPLER IN OPEN

INGUINAL HERNIA REPAIR.CLINICAL CASE

CHAPTER FOUR: LICHTENSTEIN OPERATION AND ITS

MODIFICATION

CHAPTER FIVE: CHOOSING THE OPTIMAL CHOICE FOR

MESH FIXATION DURING OPEN INGUINAL HERNIA REPAIR

5.1. Choice of optimal herniostapler. Herniostapler Covidien R versus 88 Herniostapler PPP-Kazan R

5.2. Choice of optimal adhesive mesh. Self-Gripping Mesh Progrip TM 100 versus Adhesix TM

5.3. Self-Gripping Mesh versus Tack 109 Fixation

5.4. Tack Fixation versus Sutured 115 Fixation

5.5. Sutured Fixation versus Tack Fixation versus Self-Gripping 119 mesh

RESULTS

DISCUSSIONS

CONCLUSIONS

CLINICAL RECOMMENDATIONS

ABBREVIATION LIST

LIST OF SOURCES AND LITERATURE

Введение диссертации (часть автореферата) на тему «Mesh fixation methods during open inguinal hernioplasty (Сравнение способов фиксации синтетических имплантатов при паховых герниопластиках передним доступом)»

INTRODUCTION

The relevance of the study. Inguinal hernia is considered the most common surgical diseases requiring surgical intervention. Developing surgical techniques aimed at eliminating this pathology has a long history. [Sajid M.S., Krakiunas L., Singh K.K., Sainz P., Baig M.K., 2013].

There are over 300 hernia repair methods. Many complications (up to 60%) and recurrence after surgical interventions as simple (up to 20%) as combined (up to 40%) inguinal hernias corresponds to this unresolved problem. [Zhebrovsky V.V., 2005; Nyhus L.M., Klein M.S., Rogers F.B., 1991]. In the early 70s, I. Lichtenstein developed the tension-free hernia repair technique for all types of inguinal hernias. [Lichtenstein I.L., Shulman A.G., Amid P.K., 1993], and now the Liechtenstein operation has become the gold standard for the surgical treatment of patients with anterior inguinal hernia repair [Simons MP, Aufenacker T, et al., 2009].

The Russian guidelines by the Russian Hernia Society for inguinal hernia (approved by the Ministry of Health of the Russian Federation, 2021) approved that, inguinal hernias are observed more often in men than in women [Lavrova T.F., 1979., RHS.2021]. In planned operations for inguinal hernias, the first place among all operations remaining Lichtenstein operation [Chizhov D.V. et al., 2004].

In Russia, there are about 150 thousand operations per year done by classical methods. Recurrence occurs in 10-15% of all patients operated on for this reason. More than 28 million dollars per year are spent on the redo of this operation for patients with recurrent inguinal hernias. [Shelyakhovsky I.A., Chekmazov I.A., 2002].

In the European Hernia Society recommendation, the Lichtenstein method, and laparo-endoscopic techniques (TAPP/TEP) are considered the possible options for the treatment of primary unilateral inguinal hernias, provided that the surgeon has sufficient experience in a particular operation [Simons MP, Aufenacker T. et al., 2009].

Professor Protasov A.V. claims that prosthetic hernioplasty techniques have firmly taken the most important place in modern surgery, reducing the frequency of hernia recurrence to an average of 4% [Mitin S.E., Chistyakov D.B. et al., 2004; Protasov A.V. et al., 2016].

Despite the widespread use of mesh implants in herniology, there are several practical issues that raise doubts, even among experienced surgeons. One of them is the choice of the mesh fixation method, depending on the adequacy of many factors that cause the acceleration of surgical intervention [Novitsky Y.W., Harrel A.G., Crisiano J.A. et al., 2007]. Secure fixation should be pursued by patients with a mesh and thus at risk of hernia recurrence. In addition, the method of mesh fixation should be safe and prevent the development of chronic pain syndrome in the postoperative period, the frequency of which, according to different authors, ranges from 10 to 54% in those who underwent inguinal hernioplasty. [Rustamov E.G., 2010; Magnusson N., Hedberg M., Osterberg J. et al.; 2010].

Literature review. After analyzing the literature, we found more than 100 studies on this topic, the results of which have already been published in various peer-reviewed journals with different mesh fixation methods for open inguinal hernia repair in recent years, which confirms the relevance of the problem around the world.

Degree of development of the topic. At present, despite the wide choice of different surgical techniques for the open surgical treatment of patients with inguinal hernias, the Liechtenstein operation remains the "Gold Standard". According to our research, the choice of one or another mesh implant and the method of its fixation can influence the postoperative results.

However, mesh implants based on polypropylene remain the most frequently used, which cause a pronounced reaction of surrounding tissues to a foreign body, because of which a rough connective tissue scar may develop. To improve the results of surgical treatment, many surgeons and researchers use other types of mesh implants, such as Adhesix and Progrip, which are quite often used in a lot of

European countries. The second point of attention is the method of best fixation for the mesh implants. There is still no consensus on the best mesh material and how to fix it.

Meanwhile, there are no works that reliably demonstrate the most optimal methods for fixing a mesh implant in patients with inguinal hernioplasty using an anterior approach.

Thus, there is a need to conduct a study aimed at choosing the optimal option for mesh fixation during inguinal hernioplasty using the anterior Liechtenstein approach.

The purpose of the study is to improve the results of surgical treatment in patients with inguinal hernias by optimizing the mesh fixation methods in open inguinal hernioplasty.

The research objectives

1. Implement and use of herniostapler fixing devices and tack fixation for mesh fixation during open inguinal hernioplasty.

2. Comparison between using COVIDIEN R versus PPP-KAZAN R fixing devices during mesh fixation for open inguinal hernioplasty.

3. Comparing between using ProGrip™ versus Adhesix™ mesh during anterior inguinal hernioplasty.

4. Comparative study between using self-gripping meshes and sutured meshes during open inguinal hernioplasty.

5. Comparative study between using herniostaplers versus using sutures for mesh fixation in anterior inguinal hernia repair.

6. Choose the optimal fixation choice from (herniostaplers, sutures, or self -fixing mesh) and obtain the clinical recommendation by priorities for mesh fixation during open inguinal hernia repair.

The scientific novelty. Introducing for the first time in our practice the usage of herniostaplers for open inguinal hernioplasty as a mesh fixation method for patients with inguinal hernias in anterior inguinal hernioplasty.

Comparing between two fixation devices Covidien R absorb tack and ppp-kazan R absorb tack for mesh fixation during open inguinal hernioplasty for patients with unilateral inguinal hernias and choose the optimal variant from them.

Comparing between using Progrip TM and Adhesix TM self-gripping mesh and choosing the optimal one to work with. Comparing between using self-gripping meshes and sutured meshes with tacked fixed meshes.

A comparative characteristic is made between the usage of the classic Lichtenstein operation with the use of suture as a method of fixation and two other methods (the use of a herniastaplers with fixing by tacks and the use of a self-fixing mesh) during open inguinal hernia repair.

The theoretical and practical significance of the work. Using self-gripping meshes (Progrip TM and Adhesix TM) as an alternative fixation method for open inguinal hernioplasty reduced the time of operation, the recurrence rate, and postoperative complication.

As the second option using CovidienR Absorb tack fixing device during mesh fixation for open inguinal hernioplasty has a mean in the time of operation and reduction of the recurrence rate.

Methodology and research methods

The research was performed according to the principles and rules of evidence-based medicine based on modern clinical, laboratory, instrumental and statistical research methods.

The object of the study were patients with unilateral inguinal hernias.

The subject of the study was the analysis of the results of comparing the mesh fixation methods for patients with inguinal hernioplasty by using the anterior approach in the surgical department of the Clinical Federal Hospital No. 85 in Moscow from 2016 to 2020.

Main provisions for the PhD defense

1. The introduction of herniastaplers for mesh fixation during open inguinal hernioplasty using the anterior Liechtenstein approach can significantly reduce the time of the surgical operation, reduce the level of postoperative pain, and reduce the recurrence rate.

2. The introduction of herniastaplers for fixing a mesh in inguinal hernioplasty using the anterior approach according to Liechtenstein makes it possible to more standardization of the surgical intervention.

3. There is no clear difference between Progrip and Adhesix self-gripping meshes in almost all aspects of the comparison.

4. When comparing between a self-gripping meshes and a herniastapler, the use of a self-gripping mesh is superior to a herniostapler in many aspects, especially the time of operation and long-term results.

Implementation of research results. The results of the research are implemented in the practice of the surgical department of the Clinical Federal Hospital number 85 under the Federal Medical and Biological Agency of the Russian Federation which is the Clinical base of the Department of Operative Surgery and Clinical anatomy of People's Friendship University of Russia. The research results were also implemented in the teaching process for the third- and fourth-year students in the department of operative surgery and clinical anatomy named after I.D. Kirpatovsky of Medical Institute of RUDN-University.

Approbation of research results. The results of the research and the main provisions of the dissertation work were reported and discussed at the Department meeting (The Department of Operative Surgery and Clinical Anatomy named by I.D. Kirpatovsky of the RUDN university). At different conferences such as the modern paradigm of scientific knowledge: actuality and prospective in 2019,2020 and 2021, the ENDOFEST 2021 in Moscow. Also, at the conference (SCIENCE4HEALTH) in 2021. Discussed as professional qualifying work and scientific qualifying work to complete the Phd-programm on an excellent degree.

Publications. Based on the materials of the dissertation, more than 8 papers have been published, including 4 papers in journals included in the list approved by the Higher Attestation Commission of the Ministry of Education and Sciences of the Russian Federation and indexed in the Scopus database.

The structure and volume of the thesis. The dissertation is presented on 152 pages of typewritten text and consists of an introduction, 5 chapters, a discussion of the results and a conclusion, practical recommendations, a list of sources and references, and an abbreviation list. The text is illustrated with 60 figures, 7 graphs, and 8 tables with a control chart of the study on all patients involved in the work.

Заключение диссертации по теме «Хирургия», Мекхаеэль Мекхаеэль Шехата Факхри

CONCLUSIONS

1. In inguinal hernioplasty with an anterior approach using the COVIDIEN herniastapler, the operation time is significantly reduced (10 minutes less), the number of complications in the short term follows up (in the first group in 4 patients, while in the second in 14 patients) and the sensation of a foreign body (less by the first fixing device in 5 patients and the second in 12 patients) compared with PPP-KAZAN.

2. In anterior hernioplasty using the self-locking (ADHESIX self-gripping mesh), the duration of the operation is reduced by an average of almost 5 minutes compared to the (PROGRIP self-gripping mesh implant). There are no significant differences between these groups in terms of the duration of hospitalization, or the increase in the risk of postoperative pain and the increase in the risk of post-operative complications. The use of both mesh implants showed no complications within 6 months of follow-up.

3. A comparative analysis of the use of self-fixing mesh implants and hernia stapler showed that the duration of the operation when using self-fixing implants is on average almost 8 minutes less than when using a hernia stapler. The duration of hospitalization does not differ. At a 6-month follow-up, the use of hernia staplers with fixation in such a way can cause a feeling of a foreign body in 1% of cases.

4. In a comparative analysis of hernioplasty using implant fixation with a thread, hernia stapler, and self-fixing implants, the maximum operation time when using the sutured fixation. There were no significant differences in length of hospitalization. The use of mesh endoprostheses fixed with an interrupted suture is significantly associated with chronic pain in the long term.

CLINICAL RECOMMENDATIONS

For choosing the mesh fixation method during open inguinal hernia repair.

1. If the choice of fixing device will be between Covidien R Absorb tack fixing device and PPP-KazanR fixing device, so choosing the first one will be much more effective than the last one.

2. If the choice for the surgeon will be between using Either Adhesix TM or Progrip ^ so the choice will be for Adhesix TM.

3. If the choice will be between using SGM (Adhesix TM) and using Herniostapler Covidien fixing device so it will be better to use S.G.M.

4. when the choice will be between using the herniostapler (Tacks) or sutures for mesh fixation, we can use tack fixation as a choice.

5. When we have a variable choice between (Self fixed mesh, sutured fixed mesh and tack fixed mesh) we can go for Self-gripping mesh as a first choice and secondly for the tack fixation because of the up mentioned causes in our study.

In brief, we can assume them as practical recommendations in the next points.

1. When performing a hernioplasty operation for an inguinal hernia, the use of a self-fixing mesh either PROGRIP or ADHESIX type is most justified.

2. For an open inguinal hernia repair according to using a hernia stapler, the best results are for use of the Covidien fixing device than Ppp-kazan fixing device.

3. When performing hernioplasty for an inguinal hernia, choosing between fixation methods between a self-fixing implant, a hernia stapler, and a thread, preference should be given to self-fixing meshes, then staplers.

Список литературы диссертационного исследования кандидат наук Мекхаеэль Мекхаеэль Шехата Факхри, 2022 год

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