Transabdominal preperitoneal alloplasty of inguinal hernias using a nanomodified mesh implant

Vinnytsia

* The difference relatively to group I is statistically significant (p<0.05).

Results of surgical treatment. Statistically, significantly better results were obtained in patients of group I, in whom surgical treatment used improved methods of surgical treatment of transabdominal preperitoneal alloplasty of inguinal hernias and developed nanomodified polypropylene mesh with antiseptic polyhexamethylene guanidine chloride. In contrast to patients of group II, in whom the surgical treatment used classical techniques of transabdominal preperitoneal alloplasty of inguinal hernias of the abdomen, and also used a classic polypropylene mesh. Seroma was detected much less frequently in group I than in group II (p <0.05). Seroma was detected in 1.4% (i.e., in 1 patient out of 71 study patients) of group I patients, in contrast to 7.0% (i.e., in 5 out of 71 studied patients) of group II patients. Chronic pain in the abdominal wall area within 6-8 months after surgery was observed in 5.6% (i.e., in 4 out of 71 patients studied) of group II patients, which was eliminated by prescribing physiotherapy and nonsteroidal anti-inflammatory drugs in contrast to the group I where such complications were not detected at all. Hernia recurrences were found in 8.5% (i.e., six out of 71 studied patients) of group II patients in contrast to 1.4% (i.e., one patient out of 71 studied patients) of group I patients. The duration of inpatient treatment in group I was 2.3±1.2 days, in group II - 5.2±1.1 days. From the above materials, it is known that in the surgical treatment of abdominal hernias with the use of an improved method of transabdominal preperitoneal alloplasty and developed nanomodified polypropylene mesh with antiseptic polyhexamethylene guanidine chloride; it is possible to reduce by two times the length of stay of patients in the hospital and to improve the course of the postoperative period of these patients in contrast to the group of patients in whom surgical treatment of abdominal hernias used classical methods and classic polypropylene mesh.

In connection with performing an improved technique of transabdominal alloplasty of inguinal hernias using the developed nanomodified polypropylene mesh implant with antiseptic polyhexamethylene guanidine chloride [4, 5, 10], which provided for the isolation of the hernial sac and mobilization of the preperitoneal space at the level of the Cooper ligament and iliac vessels, as well as the placement of the developed nanomodified polypropylene mesh implant with antiseptic size 10x10 cm at the level of these anatomical structures. Mesh fixation was performed with Securestrap herniostepler to the muscles, aponeurosis, and Cooper's ligament along the upper medial edge. The surgery was completed by closing the parietal peritoneal defect and draining the wound with PVC drainage of the space above the mesh. After that, the trocar was removed, and the trocar wounds were sutured. An aseptic dressing was applied to the wounds. Drainage was removed on the first day after surgery. The course of the early and long-term postoperative period in almost all patients was without complications. For anaesthesia, Ketorol was administered at a dose of 1.0 g twice a day. In order to prevent stress ulcers of the gastrointestinal tract, Kvamatel was prescribed according to the scheme. Antibacterial therapy with cefosulbine 1 g twice daily was continued because patients had an increased risk of infectious complications from the wound. Prevention of thromboembolic complications was carried out with Clexane at a dose of 40 mg for 7-9 days. Sutures were removed on day 3, and patients were discharged from the hospital. This technique was performed in 71 patients. In contrast to patients who performed the classic transabdominal alloplasty of inguinal hernias using the traditional polypropylene mesh, significantly reducing postoperative purulent-inflammatory complications in both early and remote postoperative periods, confirmed by statistical data, the licensed data analysis program STATA 12 was applied. According to the literature, seroma in such operations is observed in 7.0% of patients. When performing an improved method of surgical treatment using the developed nanomodified polypropylene mesh with antiseptic polyhexamethylene guanidine chloride, seroma was observed in 1.4% of patients (i.e., in 1 patient out of 71 patients studied), which used the developed nanomodified polypropylene mesh with antiseptic polyhexamethylene guanidine chloride, which is confirmed by statistics (p=0.409). Comparison of qualitative parameters in groups with an estimation of the statistical probability of difference was performed by comparing proportions (Z-criterion), Chi-square criterion (%2) and Fisher's exact criterion. Analysis of the relative risk of complications in patients was determined by calculating the odds ratio (OR) with a 95% confidence interval - OR (95% CI). Recurrence of hernia in such surgical interventions was observed in 8.5% of patients. When using advanced methods of surgical treatment using the developed nanomodified polypropylene mesh with antiseptic polyhexamethylene guanidine chloride, it was observed in 1.4% (i.e., in 1 patient out of 71 ones), who used an improved technique and developed nanomodified polypropylene mesh with antiseptic polyhexamethylene guanidine chloride, which was confirmed by statistics (p=0.175). The analysis of the relative risk of complications in the main and comparison groups was determined by calculating the odds ratio (OR) with a 95% confidence interval - OR (95% CI). Chronic postoperative pain was not observed in patients in whom the operation was performed using an improved technique using nanomodified polypropylene mesh with the antiseptic polyhexamethylene guanidine chloride. In those patients in whom surgery was performed using the classical method and the classic polypropylene mesh, complications were observed in 5.6% of patients. Thus, significantly better results of surgical treatment were in patients who used an improved technique and developed nanomodified polypropylene mesh with antiseptic polyhexamethylene guanidine chloride, compared with those who used classical treatment in surgical treatment in combination with classic polypropylene mesh. Because we used an improved technique in combination with the developed nanomodified mesh implant with the antiseptic polyhexamethylene guanidine chloride in our patients, it was possible to achieve a reduction in the frequency of seroma in the early postoperative period by five times, compared with those patients where the classical technique was used for surgical treatment in combination with the classical polypropylene mesh. There was also a significant reduction in chronic pain in the postoperative period by four times, compared to those patients where the classical technique was used for surgical treatment combined with the classical polypropylene mesh. We observed a sharp reduction in the recurrence of hernias in the postoperative period by six times, compared with those patients where surgical treatment used the classical method combined with the classical polypropylene mesh. This significant reduction in the occurrence of complications in the postoperative period is due to the improved method of surgical treatment and the properties of polypropylene mesh, which is nanomodified with carbon nanotubes and antiseptic polyhexamethylene guanidine chloride. It has a high sorption, hygroscopic and antiseptic effect, which reduces the intensity of aseptic inflammation of tissues around the mesh, serous fluid exudation and risk of infection. It reduces the risk of infection migration and shrinkage of the mesh. In contrast, classic polypropylene mesh does not have such properties.

Surgical treatment of inguinal hernias using nanomodified polypropylene mesh was more effective than using classical polypropylene mesh, as evidenced by a decrease in the seroma frequency from 7.0±1.3 to 1.4±0.3%, chronic postoperative pain - from 5.6±0.2 to 0%, hernia recurrence - from 8.5±0.3 to 1.4±0.2%. It also reduces patients' length of stay in the hospital from 5.2±1.3 to 2.3±1.2 days.

Prospects for further research. Developed nanomodified polypropylene mesh implants will be introduced into the clinical practice of surgical departments, which will significantly reduce postoperative purulent-inflammatory complications in the early and late postoperative periods and improve the quality of life of patients in the surgical treatment of abdominal hernias.

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