MODERN APPROACH TO INGUINAL HERNIA SURGERY

Abstract

Summary. The article analyzes modern clinical guidelines for the repair of inguinal hernias. In 2018, the Hernia Surge Group published clinical guidelines for inguinal hernia repair. Experts evaluated the effectiveness, advantages and disadvantages of many currently known methods of hernia repair, and with a high level of evidence recommended choosing two open (Shouldice and Lichtenstein) and two laparoscopic techniques (TAPP and TER). The Shouldice operation is considered the best if it is decided to choose inguinal hernia repair without a mesh. However, modern trends in the repair of inguinal hernias still lean toward tension-free techniques, regardless of the age and gender of the patient. Even in young men with various types of hernias, it is recommended to use a prolene mesh, which reduces the risk of recurrence without impairing sexual function and fertility indicators. The Lichtenstein repair is the standard for open (anterior) inguinal hernia repair. In endoscopic TAPP and TEP repairs, the mesh is inserted into the preperitoneal space, but the techniques differ in access to this space. Due to technical complexity and high cost, laparoscopic and endoscopic repair of inguinal hernias is primarily recommended for recurrent and bilateral hernias, as well as for comorbid operations. Both TAPP and TEP have different and rare but serious complications. The 2018 EHS guidelines recommend open (Lichtenstein) and endoscopic (TEP/TAPP) as equivalent and evidence-based options for primary unilateral inguinal hernia repair.