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Vol 11, No 1 (2009)
Published online: 2009-11-10

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Inguinal hernia repair with the peduncled fascial flap - ten years of experience

Roman Kuśnierczyk, Adam Wójcik, Wiesław Piątkowski, Marian Lorek, Marek Woźniak
Chirurgia Polska 2009;11(1):13-24.

Abstract


Background: This paper presents the outcomes of inguinal hernia repairs in 1520 patients operated on between 1998 and 2007. The musculopectineal hiatus was reconstructed with both crura of the aponeurosis of the external oblique abdominal muscle and the transverse fascia using our own technique.
Material and methods: In the 10-year period analysed, three periods were distinguished in which successive modifications of the surgical technique were used. Period I (255 repairs) - the inguinal canal alone was secured to provide protection against hernia recurrences. Period II (497 procedures) - plasticity of the inguinal canal was carried out; in patients with increased risk of development of a femoral hernia found intraoperatively, the femoral ring was additionally secured, thus complex reconstruction of the entire musculopectineal hiatus was performed. Period III (768 procedures) - complex reconstruction of the entire musculopectineal hiatus was performed in all patients, irrespective of the hernia type and the extent of fascial tissue impairment.
Results: In one case, the urinary bladder was intraoperatively injured, which was diagnosed and secured without further consequences in the postoperative course. Amongst 1520 repairs performed, 35 inguinal hernia recurrences and 14 femoral hernia recurrences were observed. In the early postoperative period, complications such as prolonged wound healing, skin hypoaesthesia around the wound or testis oedema were transient, and typical of inguinal hernia repairs from external access in terms of their number and quality.
Conclusions: Complex reconstruction of the musculopectineal hiatus, as a management standard, virtually eliminated the possibility of hernia recurrences. The modifications introduced were found to be suitable as the suggested technique secures all places of decreased resistance of the groin.

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Chirurgia Polska (Polish Surgery)