Lichtenstein inguinal hernia repair. Hernia repair (hernioplasty)

26.04.2020

and) Indications for plastics inguinal hernia Liechtenstein (inguinal hernioplasty):
- Absolute reading: with diagnosed inguinal hernia, especially in elderly patients.
- Contraindications: none, except for the absolute general inoperable state or lack of patient consent. Sensitivity to synthetic mesh prostheses.
- Alternative operations: plastic according to Shuldays or Bassini.

b) Preoperative preparation... Preoperative examinations: ultrasound procedure, dopplerography of the testicles before reoperations.

in) Specific risks, patient informed consent:
- Testicular atrophy (less than 1% of cases)
- Wound infection (2% of cases)
- Chronic groin pain (less than 2% of cases)
- Relapse (0.8-4% of cases)
- Mortality (less than 0.1% of cases)

d) Anesthesia... Local anesthesia is preferred for patients who are able to communicate, otherwise epidural or general anesthesia (intubation) is performed.

e) Patient position... Lying on your back.

e) Online access with plastic hernia orifice according to Liechtenstein... Transverse or slightly oblique incision above the groin fold.

g) Stages of hernioplasty with mesh according to Liechtenstein:
- The principle of plastics.
- Cutting out and fixing with seams of a synthetic mesh.
- Suturing to the inguinal ligament.
- Suturing to the internal oblique muscle.
- Reconstruction of the inner inguinal ring.

h) Anatomical features, serious risks, surgical techniques:
- Select a large enough mesh (6 x 14 cm).
- Warning: avoid narrowing the inner groin ring with excessively tight sutures.
- Secure fixation with sutures to the internal oblique muscle.
- Reliable closure of the pubic bone.

and) Measures for specific complications... If the inner groin ring has been narrowed too much, remove the outermost suture and reapply it.

to) Post-operative care after inguinal hernioplasty according to Liechtenstein:
- Medical care: remove active drainage on day 2.
- Resuming power supply: immediately.
- Bowel function: a small enema is possible.
- Activation: immediately.
- Physiotherapy: not necessary.
- Period of incapacity for work: 1-2 weeks.

l) Stages and technique of hernioplasty with mesh inguinal hernia:
1. The principle of plastics
2. Cutting out and stitching the synthetic mesh
3. Sewing to
4. Suturing to the internal oblique muscle
5. Reconstruction of the inner inguinal ring

1. The principle of plastics... The principle of Lichtenstein inguinal hernioplasty is to strengthen the posterior wall of the inguinal canal using a specially cut retroperitoneal mesh prosthesis. This mesh is fixed to the inguinal ligament and the internal oblique muscle directly behind the spermatic cord.

2. Cutting and stitching synthetic mesh... To strengthen the back wall, an ULTRAPRO mesh (Ethicon) measuring b x 14 cm is measured and cut out. A longitudinal incision is made in the lower half of the mesh, starting at the wide lateral edge. Sewing is performed with a continuous suture, starting with a U-stitch at the pubic tubercle, which overlaps medially by at least 2 cm.

A continuous suture extends laterally to the inner ring. Suture material - 0 polypropylene. Prior to this, the hernial sac is adjusted and, if necessary, is held by two gathering sutures. Then the spermatic cord is mobilized while preserving the cremaster. A wide overlap of the pubic tubercle with reliable fixation with sutures is important for the prevention of recurrence that occurs in the pubic tubercle and is most common.

3. Suturing to the inguinal ligament... A continuous stitch continues to the inner ring where it is tied and cut. There should be no gaps along the groin ligament (risk of recurrence).

4. Suturing to the internal oblique muscle... To fix the tongue-shaped mesh to the internal oblique muscle, separate sutures (polypropylene 0) are placed up to the inner ring at intervals of 1.5 cm. Care must be taken here to preserve the adjacent nerve trunks (ilio-hypogastric and iliac nerves).

5. Reconstruction of the inner inguinal ring... As a result of the incision made earlier, two tails are formed at the lateral end of the mesh. When the sutures reach the inner ring, the upper tail of the mesh is laid over the lower one and is fixed with one interrupted suture, which also includes the edge of the inguinal ligament. The operation is completed by stitching the aponeurosis of the external oblique muscle over the mesh, subcutaneous sutures and skin clips.

Early diagnosis hernia can be the key to success, since advanced cases are most often accompanied by complications. If you have been diagnosed with a hernia in the groin area, Liechtenstein hernia repair may be offered to remove it.

The essence of the operation

This surgical intervention is the "gold standard" for the removal of a hernia in the inguinal canal, which is carried out without tension on the adjacent tissues. During the operation, new polymers are used, and recently composite meshes have gained wide popularity, which, in turn, have a resorbing effect and contribute to a rapid regeneration process. Liechtenstein surgery is currently gaining tremendous popularity due to its simplicity and extremely low percentage of relapses and complications in all clinics in the world that specialize in the removal of hernias. Various videos on the operation and its results are available on the Internet.

Stages of the

Liechtenstein surgery is performed in all clinics under spinal anesthesia... After the introduction of anesthesia, a skin incision is made, not exceeding 5 cm, lateral from the pubic tubercle, parallel to the inguinal ligament.

The next step of the surgeon is the dissection of the tissue and the actual aponeurosis of the external oblique muscle, up to the very superficial ring of the inguinal canal. The aponeurosis of the external oblique muscle is separated from the spermatic cord to the inguinal ligament, the spermatic cord is taken on a holder, then the hernia is removed from the spermatic cord, followed by immersion deep into the abdominal cavity.

This is followed by the imposition of the mesh (the threads with which it is attached, along chemical composition are identical with her). With the first suture, the medial edge of the mesh used is sewn to the pubic periosteum, then the lower edge of the mesh is sewn to the inguinal ligament with a continuous suture. The last suture secures the edges of the mesh behind the spermatic cord, while they are sewn to the inguinal ligament, which allows you to accurately determine the diameter of the spermatic cord.

The last stage is suturing of the aponeurosis of the external oblique muscle and cosmetic suture of the skin, both sutures are continuous. Complications after this type of operation are minimal, but the risk remains.

Indications and contraindications for the operation

The indication for Lichtenstein plastic surgery is the presence of any type of hernia in the patient in the area of \u200b\u200bthe inguinal canal. This surgical intervention is a universal means of dealing with hernias in our time. If you have been diagnosed with this disease, you need to remember that not a single folk remedy you cannot get rid of it, only a timely operation can correct the current situation.

Like any other surgical procedure, the Liechtenstein method imposes a number of restrictions on patients:

The main contraindication is the individual intolerance of the patient with general anesthesia, which is mandatory for this operation, otherwise he risks getting complications.
When big size inguinal hernia, the doctor has the right to refuse to carry out this effect, because the risk of nerve damage increases, which can lead to loss of sensitivity of the area.
In the case when a person has blood diseases, for example, hemophilia, any operation is contraindicated for him. None of the drugs will be able to quickly and efficiently coagulate blood; in case of large blood loss, a lethal outcome is guaranteed.
If the patient has chronic heart and lung diseases, laparoscopy cannot be performed. During the operation, the load on the heart increases, which can aggravate the existing disease.
When the hernia is strangulated, the operation is postponed or replaced with another.
With an acute abdomen clinic of unclear etiology, the hernia cannot be removed. To do this, the doctor must establish an accurate picture of what is happening, whether there is a concomitant disease that could provoke the current condition.
With intestinal obstruction, this operation is prohibited.
If the patient has had surgery on the lower abdomen, any such surgery cannot be performed. This is done so as not to subject one area of \u200b\u200bthe body to heavy loads, which has not yet fully recovered.

If the patient does not comply with these restrictions, then he will receive complications that will require additional time.

Rehabilitation period after surgery

The entire course of the operation to remove an inguinal hernia is carried out exclusively under general anesthesia, and the time it takes is about two hours, it depends on the degree of complexity of the hernia. In this regard, the patient does not need a long hospital stay, the patient is in the ward for a day so that the doctor can observe how he is recovering from anesthesia.

The hernia does not have a recurrence, the pain syndrome subsides after the third day, which contributes to the patient's return to normal life (this can be seen in the video before and after surgery).

The stitches are removed on the day of discharge. It is not recommended to undergo strong physical exertion for a month; the patient can return to work at any time. If you study the statistics in detail, you get a result that cannot but rejoice: complications in patients do not exceed 1-2%, hernia recurrence is only (0.08%).

Positive sides

The positive aspects of the operation to remove an inguinal hernia according to the Liechtenstein method are:

Possible complications are observed only in 3-5% of patients, in all others, rehabilitation is within normal limits.
After removal of the inguinal hernia, a less pronounced pain syndrome is observed.
This technique contributes to a shorter rehabilitation period.
The patient feels a low degree of discomfort long after the operation.
If a person is allergic to general anesthesia, then the doctor can carry out this surgical intervention under local anesthesia, the patient will also not feel pain.
The operation to remove an inguinal hernia using the Liechtenstein method is the easiest to carry out.

Disadvantages of plastics according to Liechtenstein

Hernioplasty according to Liechtenstein has significant disadvantages:

There is a high risk of accidental injury to the inguinal nerves, which may result in partial or complete loss of nerve supply and sensation in the operated area.
There are cicatricial changes in the area where the spermatic cord passes through the installed implant, the consequence of this is a violation of the blood supply to the testicular tissue, which leads to its atrophy and disruption of endocrine function.
It is possible to cross the circular ligament of the uterus, which guarantees its prolapse, and it, in turn, is characterized by severe pain, bleeding and even difficulty urinating.
With this operation, there is a risk of infection, although doctors do everything in their power, suppuration is possible, inflammatory processes... If the doctor suspects the patient has inflammation or infection, then he prescribes a whole course of antibiotics to prevent this.

Liechtenstein plastic cost

The price for this operation starts in our country from 20 thousand rubles, it largely depends on the quality of the services provided, the length of hospital stay and the doctor's qualifications. The outcome and the risk of complications directly depend on it. The region of the country is an important factor in the formation of prices. Remember that you should not save on health, because it is given once in a lifetime and should be protected.

Lichtenstein's operation for inguinal hernia

Removing a hernia is a fairly common operation. It is called hernioplasty and can be tension or tension-free. The most famous method of removing an inguinal hernia today was proposed back in the 70s of the XX century. This is a tension-free plastic according to Liechtenstein. The operation is carried out in a fairly simple method and does not require special training. A special mesh endoprosthesis is used to close the hernia orifice.

When resorting to the Liechtenstein method

Hernia repair with Lichtenstein plasty is done for hernia of the inguinal canal. Today this method is considered universal, however, like any surgical intervention, this operation can not always be performed.

Limitations and contraindications

Poor blood clotting
Intestinal obstruction
Symptoms of an acute abdomen of unknown origin
Infringement of a hernia,
Serious cardiovascular pathology.

Such operations are carried out as planned. If emergency intervention is required, then a different type of operation is performed first, and hernia repair according to Liechtenstein is done later, as soon as there is such an opportunity. An absolute contraindication may be low blood coagulability, when any operations are almost impossible. The presence of severe heart failure or other heart disease can interfere with the operation. In such cases, compare possible risks and choose the least dangerous option for the patient. Surgery and anesthesia adversely affect the condition of the heart and its activity, which is fraught with significant deterioration general condition the patient.

Pros and cons of the method

Like any method of treatment, Lichtenstein inguinal hernia repair has both advantages and disadvantages that must be considered when choosing a surgical option. The characteristics of the organism of a particular patient must be taken into account, so you can avoid undesirable consequences.

Pros of plastics according to Liechtenstein

Low risk of postoperative complications (3-5%),
Fast rehabilitation.

Cons of the operation

Risk of damage to inguinal nerves
The possibility of scar changes and impaired blood supply to the testicle,
The likelihood of dissection of the circular ligament of the uterus, leading to its pathologies,
The risk of infection of the surgical wound.

How is the operation going

Lichtenstein's Inguinal Hernia Surgery is the so-called gold standard for tension-free hernia repair. It is performed using a mesh implant, with the help of which weakened tissues in the area of \u200b\u200bthe hernial orifice are strengthened. Thus, it is possible to close the gap in the tissues through which the hernial sac falls out.

The Lichtenstein plasty technique involves the use of an endoprosthesis in the form of a mesh section made of polymers or composite materials. The most modern implants, some time after their installation, are partially or completely absorbed in the body. Their composition is such that they affect the surrounding tissues and stimulate their regenerative properties. In most cases, the final result of the operation can be considered the strengthening of the tissues in the area of \u200b\u200bthe former hernia and the absence of relapses.

Intervention stages

Special preparation for this type surgical treatment not necessary. The scheme of hernioplasty is quite simple and does not require careful preparation. It can be done under general anesthesia, but spinal anesthesia is most commonly used. This method of pain relief is the most gentle and quite effective. It allows the patient not to feel pain during the operation, and the risks and negative impacts are minimal.

The Liechtenstein procedure involves making a small skin incision in the groin area. Next, the surgeon dissects the aponeurosis of the external oblique muscle, which is separated from the spermatic cord. A hernial sac is allocated, which is placed in a natural place deep in the abdominal cavity. This can be done without additional effort for small to medium-sized hernias. When the hernia is large, then the usual isolation of the hernial sac can be traumatic, therefore additional manipulations are required. In case of an inguinal-scrotal hernia, it is necessary to suture the hernial sac at the base, bandage it and partially excise it. When the bag is removed, the surgeon examines the inguinal and femoral canals to determine if there are other abnormalities.

The next stage is the plastic of the hernial orifice, namely, the application of the mesh. For this, a patch of the required size is cut out. With inguinal hernias, the average size of the finished section of the implant is about 6X10 cm. To fix the mesh, threads of the same composition are used. Implant fixation begins with the pubic tubercle. If everything is done efficiently and correctly with the capture of the upper pubic ligament, then all the plastic surgery of the inguinal canal according to Liechtenstein, as a rule, is successful. Next, fixation is performed to the inguinal ligament and lateral to the deep inguinal ring. A small incision is made in the mesh to hold the spermatic cord.

An important indicator of a well-performed implant fixation is the wrinkling of the mesh after completion of the work. This means that the plastic is made without tension, which provides good support for the tissues.

The last stage is the suturing of the aponeurosis and the implementation of the cosmetic suture.

What happens after the surgery

The mesh established during the operation grows into granulation tissue and is firmly held by the aponeurosis, acting as a support for internal organs... Full ingrowth of the mesh lasts 3-6 weeks. In the first two weeks, a limit is required physical activity and activity, during this time the patient needs the supervision of a surgeon. From about the third week, you can return to normal life, having previously coordinated the load with your doctor.

Liechtenstein operation

Video: Oblique inguinal hernia hernia repair

If the inguinal hernia is oblique, then a hernial sac is found in the elements of the spermatic cord. When the size of the bag is small, it is immersed in the abdominal cavity. With an inguinal-scrotal hernia, it is stitched near the base, tied up and excised. With direct hernias, it is invaginated into the abdominal cavity. With large hernias, sufficient isolation of the hernial sac is quite traumatic, in some cases it requires extraction of the testicle into the wound, accompanied by damage to the vessels of the spermatic cord, which leads to ischemic orchitis and testicular atrophy in the future. Therefore, in such cases, a number of authors propose not to isolate the hernial sac completely, but to cross and ligate it at the level of the inner ring of the inguinal canal. To avoid dropsy of the testicle, the anterior wall of the hernial sac is partially excised, the rest of the hernial sac is left. After the sac is isolated, the inguinal canal is carefully examined, and through the Borgos space the femoral canal is examined for femoral hernias.

Video: Operation Liechtenstein

The mesh after Liechtenstein's operation grows rapidly with granulations - complete ingrowth occurs in 3-6 weeks. Therefore, patients are recommended to have a certain limitation of physical activity after Liechtenstein's operation in the first 2 weeks. Starting with the third, patients begin physical work, sports.

Video: TAPP for recurrent inguinal hernia

Having studied the results of Liechtenstein's operations in 5000 patients, his student R.K. Amid noted a very low percentage of postoperative complications - no more than 1-2%. Hernia recurrences were observed in only 4 (0.08%) patients.

Liechtenstein operation

Lichtenstein, in the 70s, proposed the concept of an operation for inguinal hernias based on the principle of non-tensioning of tissues by implanting a mesh endoprosthesis.

Liechtenstein hernioalloplasty technique

This method is quite simple to perform and does not require very careful preparation.

Liechtenstein's surgery is usually performed under spinal anesthesia. A skin incision is made from the pubic tubercle laterally, parallel to the inguinal ligament.

When performing the Liechtenstein operation, there is no need for a wide dissection of the muscles, the skin incision does not exceed 5-6 cm.

After incision of the skin and dissection of the subcutaneous tissue, the aponeurosis of the external oblique muscle is dissected to the very superficial ring of the inguinal canal.

The upper leaf of the aponeurosis is mobilized from the underlying muscle for 3-4 cm.

Adequate mobilization of the aponeurosis is twofold, as it allows the visually locate the iliohypogastric nerve and creates ample space for mesh allograft implantation. The spermatic cord is then mobilized, but possible vascular and nerve damage must be avoided.

Taking the cord upward, the rounded end of the mesh is fixed with a monofilament thread to the pubic tubercle. This is a decisive factor in ensuring the reliability of all plastics. It is obligatory to capture the upper pubic ligament with the first 2-3 sutures to prevent femoral hernia. The mesh is fixed to the inguinal ligament with 4-5 interrupted sutures or a continuous suture. The last suture should be located lateral to the deep inguinal ring.

Along the outer edge of the mesh, an incision is made parallel to the inguinal ligament, forming two ends: a wide (2/3) at the top and a narrower (1/3) at the bottom.

The upper, wide, end is held over the spermatic cord, it crosses and is located on top of the narrow one. Thus, the spermatic cord passes through the window in the mesh. Both ends of the mesh are sewn with interrupted seams. The "window" in the mesh should have a diameter of about 1 cm. Then the upper medial edge of the mesh is fixed to the muscles with 4-5 interrupted sutures. An important criterion for the quality of the plastic is the wrinkling of the mesh after the end of the stage of its fixation, which provides the plastic without tension. The crossing of the two ends of the mesh to form a "window" creates a configuration similar to the natural one formed by the transverse fascia, which is believed to be responsible for the integrity of the inner ring in normal conditions. The excess mesh along the lateral edge is cut off, leaving at least 5-7 cm of mesh behind the inner ring. The remainder is brought under the aponeurosis of the external oblique muscle, then sutured over the cord with a non-absorbable end-to-end suture without tension.

After germination of the mesh with granulation tissue, intra-abdominal pressure is evenly distributed over the entire area of \u200b\u200bthe mesh. Aponeurosis holds the mesh firmly in place, acting as an external support when the pressure in the abdominal cavity increases.

The mesh after the Liechtenstein operation grows rapidly with granulations; complete ingrowth occurs in 3-6 weeks. Therefore, patients are recommended to have a certain limitation of physical activity after Liechtenstein's operation in the first 2 weeks. Starting with the third, patients begin physical work, sports.

Observation by a surgeon is required in the first two weeks after surgery for early detection of postoperative complications (hematomas, seromas in the area of \u200b\u200bsurgery, suppuration postoperative wound).

Lichtenstein plastic surgery for inguinal hernia

Liechtenstein surgery is a variant of plastic surgery for inguinal hernia with reinforcement of the hernial orifice with a mesh implant. This technique of hernia repair is performed in children and adult patients more often than others, but it has both advantages and disadvantages.

Lichtenstein's operation for inguinal hernia is the "gold standard" surgery for removing a defect in the groin without tensioning the natural tissue surrounding the hernial sac. During the operation, polymer or composite meshes are used, which have the ability to dissolve over time and promote the healing of injured tissues.

How is hernioplasty performed?

The operation has a small number of contraindications and risks; special preparation for the surgical intervention is not required. Lichtenstein inguinal hernia repair is performed under spinal anesthesia, less often general anesthesia is used for this.

Creation of access to the hernial sac - an incision of about 5 cm is made.
Dissection of the oblique muscle aponeurosis to the inguinal ring.
Fixation of the aponeurosis with a holder.
Isolation of a hernia, return of organs to their anatomical place.
Installation of a surgical mesh.
Suturing of the aponeurosis, the imposition of absorbable sutures.

Liechtenstein's method is suitable for any kind of hernia in the groin. This is one of the main options for getting rid of a hernia with a minimal risk of recurrence. When other techniques involve suturing the defect with surrounding tissue, Liechtenstein hernioplasty uses a mesh that prevents re-protrusion, which is the main advantage of the method.

The criterion for the quality of the operation will be the wrinkling of the mesh implant, this indicates the performed plastic surgery without tissue tension, which guarantees good maintenance of the hernial orifice.

Contraindications to surgery

Limitations and contraindications for Lichtenstein plastics:

intolerance to anesthesia can become an obstacle to the operation, pain relief in this case will end in complications;
at strangulated hernia an emergency open operation, plastic is transferred or canceled altogether;
when there are symptoms of an acute abdomen, the operation is not performed until the exact clinic and the cause of the serious condition are clarified;
with a large hernia, some surgeons refuse to perform the Liechtenstein operation, predicting a relapse after plastic surgery;
previous surgery on the abdominal cavity is a contraindication to plastic surgery with mesh implant fixation;
chronic heart disease, bleeding disorders will also limit the choice of surgical treatment;
intestinal obstruction will be an absolute contraindication.

Benefits of plastics according to Liechtenstein

The operation became widespread due to the absence of the tension factor of the tissues surrounding the hernia, which reduced the number of patients with relapse after surgical treatment. This technique also eliminates many postoperative complications associated with the cardiovascular system.

What other advantages does Lichtenstein inguinal canal plastic have:

reduction of the incidence of postoperative complications by 10 times;
relatively short rehabilitation period;
lack of severe pain after surgery;
the possibility of performing plastic surgery under anesthesia without anesthesia;
simple execution technique, which reduces the risk of a surgeon's error.

Disadvantages of the method

Among the disadvantages of Liechtenstein plastic surgery, surgeons distinguish the following factors:

the risk of injury and damage to the nerves in the groin, which may result in loss of tissue sensitivity in the operated area;
there is always a risk of infection, but after the operation, doctors do everything possible to prevent purulent inflammation, and much depends on the patient himself;
women have a risk of damage to the uterine ligament, which will lead to its prolapse, this complication is characterized by bleeding and severe pain syndrome;
cicatricial changes can cause ischemia, testicular atrophy and dysfunction of the glands.

The likelihood of complications and recurrence of a hernia will depend on the accuracy of the diagnosis and the professionalism of the doctor, especially when it comes to operating on young children.

The reason for the re-development of the disease can be the fixation of an implant that is not suitable for the size and poor-quality treatment of the hernial sac. In addition to recurrent inguinal hernia, there are other equally disturbing consequences of the operation.

Possible complications

The surgeon always warns of the risk of complications before the operation:

infection of the wound and suppuration of the seams;
damage to organs in the hernial sac and injury to surrounding tissues;
inaccurate fixation of the implant with its subsequent migration;
recurrence of the disease, the development of postoperative hernia;
complications after the administration of an anesthetic drug;
hemorrhage with the formation of a hematoma.

Rehabilitation

Most of the complications can be prevented by observing the rules of prevention in the early postoperative period. After the plastic surgery performed under general anesthesia, the initial recovery lasts 2 days, then the patient is discharged home, but within 2 weeks is observed by the surgeon. In the first 14 days after the plastic surgery, a gentle diet is prescribed to exclude constipation and bloating. The patient should refrain from physical activity and regularly wear a groin brace while doing daily activities.

IN early period after the operation, you can observe changes in the groin area:

swelling of the skin in the perineum;
darkening in the area of \u200b\u200bthe surgical suture;
numbness or increased sensitivity;
slight bruising.

These symptoms are the normal response of the operated area to hernia repair. To keep the condition within the normal range, it is important to take precautions.

In the first week, it is recommended not to drive a car, it is also important to exclude conditions that will provoke coughing or sneezing. A few days after plastic surgery, the scar must be protected from water. In the later period after the operation, the doctor may prescribe physical therapy and physiotherapy.

Methods for surgical removal of a hernia: tension and tension-free hernioplasty

One of the most popular tension-free surgeries is the Lichtenstein hernia removal. Stages of hernia repair include closing the weak point of the anterior abdominal wall the patient's own tissues.

Tension-free hernioplasty or hernia repair with alloplasty is preferable, since there are practically no relapses after such an intervention. And use modern approach and high-quality implants reduce the risk of complications to a minimum.

Hernioplasty using the Liechtenstein technique

Hernioplasty according to Liechtenstein is used for inguinal, femoral, umbilical hernias, as well as protrusions of the white line of the abdomen. During the intervention, the surgeon opens the hernial sac, then checks its contents and places it back into the abdominal cavity. After that, the main stage of the operation is carried out - the plastic of the hernia orifice. It depends on the quality performance of this stage whether the patient will ever have a recurrence of a hernia or not.

The video shows how the Liechtenstein hernioplasty is performed:

The operation is performed under spinal anesthesia or general anesthesia. The main advantage of this type of intervention is minimal trauma to healthy tissues. Almost all hernioplasty methods involve an incision in the muscles, but the Lichtenstein technique does not allow such a dissection. The synthetic mesh is sutured to the aponeurosis, which is located above the muscles.

The implant is sutured to the hernia gate with a margin, eliminating the tension of the patient's own tissues. After performing a Liechtenstein operation, the doctor conducts a high-quality stop of bleeding and carefully sutures the wound in the inguinal canal.

Due to the fact that the incision does not exceed 6 centimeters, and cosmetic sutures are used to close the wound, a small scar remains in the inguinal canal after recovery.

Hernioplasty according to Liechtenstein can be performed both open and laparoscopically. In this case, several small incisions, 1-2 centimeters long, are made to access the protrusion. A laparoscopic camera with a light source is inserted into these incisions, the image from which is transmitted to a monitor in front of the surgeon. Surgical instruments are also introduced, with which the doctor performs the same stages of hernioplasty as with open access.

Liechtenstein's laparoscopic hernioplasty has a number of invaluable advantages over traditional interventions. Due to small incisions, a smaller area of \u200b\u200bhealthy tissue is damaged, which ensures a quick recovery period. Intensity pain in early postoperative period less pronounced, and complications during laparoscopy are rare.

Types of hernia repair for the treatment of inguinal hernia

For the treatment of inguinal hernia using the method of tension-free hernioplasty, the Liechtenstein operation is used. In cases where it is necessary to use a tension version of the intervention, Bassini plastic surgery of the inguinal canal is most often used. Indications for its use are for the first time formed straight and oblique inguinal protrusions of a small size. The main difference between this method of hernioplasty from the rest is the plastic of the inguinal canal by stitching the internal oblique and transverse abdominal muscles and transverse fascia to it.

Sholdyce hernia repair is the most acceptable from an anatomical point of view. With this operation, the posterior wall of the inguinal canal is strengthened and a deep hole is formed. In order to reduce the hernial orifice, a circular excision of the inguinal canal is performed with further suturing with a double continuous suture.

Hernia repair according to Postemsky is carried out in order to remove the inguinal canal. Thus, after the intervention, there is completely no risk of re-development of an inguinal hernia on the operated side. Since the spermatic cord passes in the inguinal canal, during the intervention it is sutured to the muscle groups of the anterior abdominal wall and is located in the subcutaneous fat.

Other types of hernioplasty

For each patient, the way in which hernia repair will be performed is selected individually. There are many options for hernias and ways to remove them. Each method has its own advantages and disadvantages.

However, if you choose the right variant of the operation, then only the advantages will be realized.

For example, such an option as Martynov's hernia repair is used only for oblique inguinal hernias. Mayo hernia repair is used for umbilical protrusions and formations of the white line of the abdomen.

Hernia repair according to Sapezhko is a variant of tension hernioplasty umbilical hernia... A feature of the intervention is the removal of the navel with subsequent plasty of the umbilical ring with the rectus abdominis muscles.

Hernia repair according to Duhamel and Krasnobaev also refer to the tension methods of plastic surgery of the inguinal canal. They are used in children after 6 months. These operations provide good strengthening hernia orifice and no recurrence. Moreover, tension hernioplasty in children is preferable to tension-free. This is due to the fact that during the growth of the child, the implant is stretched and after a while must be replaced.

Recovery after hernia repair

The recovery period after the treatment of a hernia, including after hernia repair according to Liechtenstein, proceeds favorably if the operation took place without complications and the patient fulfills all medical prescriptions. Of course, the duration of rehabilitation varies depending on the treatment option. As for hospitalization, after laparoscopic surgery, the patient is hospitalized for 2-3 days, and after open surgery - for 5-8 days.

Successful rehabilitation after hernia repair is achieved through the following measures:

Eliminate heavy lifting;
Limit physical activity;
Follow a diet;
To refuse from bad habits;
Engage in physiotherapy exercises.

An optimally selected and well-performed hernia repair provides a good postoperative result without relapses and complications.

IN modern world surgeons have to increasingly remove a hernia, especially an inguinal, and if earlier problem affected mainly athletes, nowadays any person is subject to it. Early diagnosis of hernia can be the key to success, since advanced cases are often accompanied by complications. If you have been diagnosed with a hernia in the groin area, Liechtenstein hernia repair may be offered to remove it.

The essence of the operation

Stages of the

Liechtenstein surgery is performed in all clinics under spinal anesthesia. After the introduction of anesthesia, a skin incision is made, not exceeding 5 cm, lateral from the pubic tubercle, parallel to the inguinal ligament.

This is followed by the imposition of the mesh (the threads with which it is attached are identical in chemical composition with it). With the first suture, the medial edge of the mesh used is sewn to the pubic periosteum, then the lower edge of the mesh is sewn to the inguinal ligament with a continuous suture. The last suture secures the edges of the mesh behind the spermatic cord, while they are sewn to the inguinal ligament, which allows you to accurately determine the diameter of the spermatic cord.

Indications and contraindications for the operation

The indication for Lichtenstein plastic surgery is the presence of any type of hernia in the patient in the area of \u200b\u200bthe inguinal canal. This surgical intervention is a universal means of dealing with hernias in our time. If you have been diagnosed with this disease, you need to remember that not a single folk remedy can get rid of it, only a timely operation can correct the current situation.

Like any other surgical procedure, the Liechtenstein method imposes a number of restrictions on patients:

The main contraindication is the individual intolerance of the patient with general anesthesia, which is mandatory for this operation, otherwise he risks getting complications.
In the case of a large inguinal hernia, the doctor has the right to refuse to carry out this effect, because the risk of nerve damage increases, which can lead to loss of sensitivity of the area of \u200b\u200bthe area.
In the case when a person has blood diseases, for example, hemophilia, any operation is contraindicated for him. None of the drugs will be able to quickly and efficiently coagulate blood; in case of large blood loss, a lethal outcome is guaranteed.
If the patient has chronic heart and lung diseases, laparoscopy cannot be performed. During the operation, the load on the heart increases, which can aggravate the existing disease.
When the hernia is strangulated, the operation is postponed or replaced with another.
With an acute abdomen clinic of unclear etiology, the hernia cannot be removed. To do this, the doctor must establish an accurate picture of what is happening, whether there is a concomitant disease that could provoke the current condition.
With intestinal obstruction, this operation is prohibited.
If the patient has had surgery on the lower abdomen, any such surgery cannot be performed. This is done so as not to subject one area of \u200b\u200bthe body to heavy loads, which has not yet fully recovered.

If the patient does not comply with these restrictions, then he will receive complications that will require additional time.

Rehabilitation period after surgery

The hernia does not have a recurrence, the pain syndrome subsides after the third day, which contributes to the patient's return to normal life (this can be seen in the video before and after surgery).

Positive sides

The positive aspects of the operation to remove an inguinal hernia according to the Liechtenstein method are:

Possible complications are observed only in 3-5% of patients, in all others, rehabilitation is within normal limits.
After removal of the inguinal hernia, a less pronounced pain syndrome is observed.
This technique contributes to a shorter rehabilitation period.
The patient feels a low degree of discomfort long after the operation.
If a person is allergic to general anesthesia, then the doctor can perform this surgical intervention under local anesthesia, the patient will also not feel pain.
The operation to remove an inguinal hernia using the Liechtenstein method is the easiest to carry out.

Disadvantages of plastics according to Liechtenstein

Hernioplasty according to Liechtenstein has significant disadvantages:

There is a high risk of accidental injury to the inguinal nerves, which may result in partial or complete loss of nerve supply and sensation in the operated area.
There are cicatricial changes in the area where the spermatic cord passes through the installed implant, the consequence of this is a violation of the blood supply to the testicular tissue, which leads to its atrophy and disruption of endocrine function.
It is possible to cross the circular ligament of the uterus, which guarantees its prolapse, and it, in turn, is characterized by severe pain, bleeding and even difficulty urinating.
With this operation there is a risk of infection, although doctors do everything in their power, suppuration and inflammation are possible. If the doctor suspects the patient has inflammation or infection, then he prescribes a whole course of antibiotics to prevent this.

Liechtenstein plastic cost

Ministry of Health of Ukraine

Zaporizhzhya State Medical University

Department of Operative Surgery and Topographic Anatomy

on the topic: Hernioplasty according to Liechtenstein

Completed: 2nd year student of 2nd group

faculty of Medicine

Kalashnik Kirill Vadimovich

Checked by: Lubomirskaya Victoria Anatolyevna

Zaporizhzhia

The most significant development in surgery in the 1980s was the birth of operative endoscopy. At the dawn of its development, it seemed that in a few years any surgical intervention could be successfully performed using a video system under the control of a monitor. Over time, the stage of euphoria gave way to a period of common sense, understanding the limitations and possibilities of endoscopic surgery.

One of the operations proposed for the laparoscopic approach was inguinal hernioplasty using an endoprosthesis (polypropylene mesh). With the accumulation of experience, the attitude towards this intervention became more restrained, but the mesh endoprosthesis was successfully used in "open" surgery. The head of the Training Center of Endoscopic, Molo-invasive and Aesthetic Surgery, Associate Professor of the Department of Endoscopic and general surgery KSMA, dr honey... sciences Igor Vladimirovich Fedorov.

Do you know that:

In 1892, E. Bassini reported a radical three-layer hernioplasty with a brilliant result for those times: only 8 relapses in 206 operations three years after surgical treatment. The results of his predecessors were significantly different: 30-40% of relapses during the first year and 100% - 4 years after surgery.

A few years ago, it seemed that the problem of surgical treatment of abdominal wall hernias was finally and irrevocably solved. Self-repair, performed under local or regional anesthesia, gave good results with zero mortality and a low complication rate. However, according to the WHO, this is only true for simple hernias. In difficult cases, which include straight and bilateral inguinal, postoperative ventral and any recurrent hernias, the results are much worse. So, with direct inguinal hernias, the percentage of recurrence reaches 10, and the probability of repeated recurrence is 40% (for postoperative hernias - up to 50%)! The likelihood of developing hernias after primary laparotomy ranges from 1 to 10% over a three-year period. These statistics have become a serious challenge to surgeons who operate on hernias of the abdominal wall.

For many years, the reasons for failures in the treatment of complex hernias were considered technical mistakes of the surgeon, the wrong choice of the operation option, the comparison of heterogeneous tissues, etc. However, the technique of hernia repair has been developed in detail throughout the twentieth century, and all surgical schools promote, in fact, the same principles. Unfortunately, this does not lead to a decrease in relapse rates.

A natural conclusion from the accumulated experience is that the cause of the disease recurrence is different. Namely, in the failure of own tissues of the anterior abdominal wall, used for hernioplasty. Due to the mobilization of tissues, the latter experience tension and ischemia. It is possible to close a hernial defect without tension using a synthetic endoprosthesis.

Do you know that:

The need to use a prosthesis for inguinal hernia repair was recognized as early as the 19th century. Various materials were tested, including the patient's own tissues. Thus, the fascia of the back was considered optimal for this purpose, which was used as a suture material, with plastic "on a leg" or in the form of a free graft. Unfortunately, it turned out that over time, the fascia tissue weakens, and when infected, it is rejected.

In 1975, Stoppa was the first to report on inguinal hernioplasty using a pre-peritoneal mesh prosthesis. The main point of the technique was to align tissues without tension. Subsequent years were spent looking for material that would not cause rejection, suppuration and other complications.

Requirements that the material must meet for an ideal endoprosthesis:

1. chemical inertness;

2. mechanical strength;

3. easy sterilization;

4. water permeability and germination by body tissues;

5. Sufficient resistance to intra-abdominal pressure or external influences;

6. stimulation of germination by fibroblasts (as opposed to the reaction of rejection or sequestration);

7. not cause reactions of inflammation or rejection;

8. transformation into the desired shape;

9. the ability of fibers not to entangle or separate;

10. not cause allergies or hypersensitivity;

11. absence of carcinogenic properties;

12. not be perceived by the patient as a foreign body (be sufficiently rigid and hard);

13.do not modify physical properties under the influence of tissue fluid.

It has been proven that polypropylene matches these qualities to the greatest extent (Fig. 1). It is hypoallergenic and non-carcinogenic. An endoprosthesis made of this material quickly engrafts (due to the growth of fibroblasts into it), and the probability of relapse when using it ranges from 0 to 0.5%.

Fixation of the mesh can be carried out both using a thread similar in chemical composition, and special automatic devices (staplers). The mechanization of the fixation of implants makes it possible to significantly simplify and accelerate the stage of reconstruction of the inguinal canal. In addition, when carrying out plastic surgery of the inguinal canal, it is possible to use polymer meshes that do not require their direct fixation. This effect is achieved by increasing the thickness and weight of the implant (Herniamesh) or introducing into the mesh chemical substances, forming a physicochemical adhesion to tissues (Sofradim).

Developed and general principles implantation of prostheses, which include the following points:

1. To prevent the formation of seromas during implantation, it is necessary to avoid direct contact of the prosthesis with the subcutaneous fat.

2. The prosthesis should be located between the musculo-aponeurotic tissues in order to prevent its displacement with an increase in intra-abdominal pressure.

3. The prosthesis should be of sufficient size to overlap the edges of the hernial orifice by 2-4 cm for inguinal hernia repair and 6-8 cm for incisional herniasoh. This is necessary to evenly distribute intra-abdominal pressure over the entire area of \u200b\u200bthe implant. Otherwise, when using a prosthesis of insufficient size, covering only the hernial orifice, intra-abdominal pressure will act on a much smaller area, which will lead to an increase in the load along the suture line.

4. It is always necessary to fix the prosthesis around the periphery to prevent it from wrinkling and displacement. After fixation to the tissues, the prosthesis should lie relatively freely, with folds and without tension, which in turn will compensate for the increase in intra-abdominal pressure during physical activity of the patient and the decrease in the size of the implant as a result of scar formation.

5. It is necessary to avoid direct contact of prostheses made of non-absorbable materials with the visceral peritoneum to prevent the development of adhesions in the abdominal cavity, adhesive intestinal obstruction, ingrowth of the mesh into organs and the formation of intestinal fistulas.

6. It should be used for prophylactic purposes broad-spectrum antibiotics during operations for recurrent and incisional hernias, when using large-sized prostheses, as well as when draining a postoperative wound.

7. Do not use implants made of non-absorbable materials for contaminated operations.

8. Avoid the use of multifilament sutures for fixing macroporous prostheses, which is associated with a high risk of infection.

All modern synthetic non-absorbable prostheses can be subdivided into 5 types depending on the pore size and structure.

Type I: Fully macroporous monofilament polypropylene prostheses (Lintex, Prolene, Atrium, Marlex, Surgipro and Trelex). These meshes have pores larger than 75 microns, which is a prerequisite for the penetration of macrophages, fibroblasts, blood vessels and collagen fibers in the pores and resistance to infection. This type of material causes active angiogenesis and a pronounced reaction of fibroblasts and serves as a scaffold for germination connective tissue, with the formation of a reliable "prosthetic" aponeurosis. Sufficient molecular permeability allows the protein-like substances of the recipient to penetrate into the pores, resulting in rapid fibrinous fixation of the mesh to the tissues, which reduces the risk of seroma formation, since the "dead space" between the mesh and tissues quickly disappears. With suppuration of a postoperative wound, there is no need to remove such a prosthesis.

II type: Fully microporous prostheses (expanded polytetrafluoroethylene Gore-Tex) with pore size less than 10 microns. Microporous materials allow bacteria to enter the pores and exclude the penetration of macrophages, therefore, when using them, the risk of infection increases. This type of prosthesis does not cause a sufficiently intense proliferative reaction and vascularization, which does not lead to the penetration of the mesh by connective tissue, but to encapsulation. In this case, a less dense scar is formed compared to the first type of materials.

III type: macroporous prostheses with multifilament or microporous components (polytetrafluoroethylene Teflon, Surgipro multifilament, Mersilene and Musgo-Mesh). The disadvantage of this group of materials is the relatively easy susceptibility to infection, which is associated with the presence of multifilament and microporous components that harbor bacteria. A more pronounced reaction to foreign body compared to type 1 of materials.

IV type: composite prostheses with surfaces of different properties (Parietex Composite, Gore-Tex DualMesh, Europlak). They are intended for intraperitoneal implantation, as they do not cause adhesions in the abdominal cavity.

V type: rigid macroporous monofilament mesh polypropylene prostheses "Herniamesh". This view As a result of special heat and mechanical treatment, meshes possess the properties necessary for seamless implantation.

Operation technique

prosthesis hernioplasty liechtenstein hernia

The incision of the skin and subcutaneous tissue with a length of 8 - 10 cm fully corresponds to that of traditional hernioplasty with local tissues. The aponeurosis of the external oblique muscle is freed from fatty tissue only along the dissection line. There is no need for its wide selection, as when creating a duplication. After opening the aponeurosis with scissors and a dissecting tupfer, the inguinal ligament, the edge of the internal oblique and transverse muscles by 2 - 3 cm, the edge of the rectus sheath and the pubic tubercle are isolated. A finger is allocated a space under the aponeurosis up the incision for the subsequent placement of the mesh prosthesis.

With a direct inguinal hernia, the hernial sac, after exposure, is not opened, but immersed in the abdominal cavity. The transverse fascia above it is sutured with one or two absorbable sutures.

With an oblique hernia, the sheath of the spermatic cord is opened. A small hernial sac is exposed up to the neck, opened and stitched in the neck area. With a large oblique and inguinal-scrotal hernia, it is sometimes more expedient to first isolate the neck of the hernial sac, suture it and bandage it, and then completely remove the bag. In our opinion, the isolation of the hernial sac should not be done with a swab, which injures the tissue, but only with scissors and forceps with coagulation of small vessels. This allows any size bag to be removed atraumatically. Leaving a part of the sac in the scrotum is considered inappropriate, especially in patients with young and mature age... After removing the sac, we restore the sheath of the spermatic cord.

Only after processing the hernial sac, the spermatic cord is bypassed with a dissector and taken to the holder. We do not see the need to perform this stage before the bag is isolated, as the author of the technique does, and we consider it more traumatic. Then the spermatic cord sharp way we release from the connection with the underlying tissues throughout the wound. It is also considered superfluous to partially cross the muscle that lifts the testicle.

With oblique inguinal hernias, when the inner inguinal ring is significantly expanded or there is a hernia with a straightened canal, we narrow the inner inguinal ring with several sutures on the transverse fascia.

For plastic surgery, we use a polypropylene mesh manufactured by Ethicon (UK) [Ethicon (UK)] in the size of 8-13 cm or a little narrower with a small groin gap. At the medial end of the mesh, the corners are rounded, from the lateral end, a longitudinal incision is made approximately 2/3 of the length of the prosthesis so that there is a wide branch on top (2/3) and a narrow one below (1/3). At the end of the incision, a round hole is made up to 1 cm in diameter for the spermatic cord.

The prepared prosthesis is placed under the spermatic cord and fixed with a continuous suture with a prolene first to the sheath of the pyramidal muscle down to the pubic tubercle, then to the pubic tubercle, without capturing the periosteum. For the prevention of relapses, it is important that the prosthesis is fixed to the indicated formations not edge to edge, but located on top of them by 1 - 1.5 cm beyond the suture line.

After that, the spermatic cord is transferred upward and with the same ligature the mesh is fixed to the Cooper ligament and the inguinal ligament to a level slightly lateral to the inner inguinal ring. Strengthening the area of \u200b\u200bformation of femoral hernias with this technique is advisable to perform in each case. To do this, after suturing the prosthesis to the pubic tubercle with the following one or two stitches, the mesh is sutured to the Cooper ligament with about 1 cm of its lower edge inward, and then further to the inguinal ligament. The folding of the mesh distinguishes the described technique from the original one proposed by Lichtenstein. We believe that this technique allows you to more fully close the area of \u200b\u200bpotential femoral hernia formation.

Then the upper edge of the mesh is fixed over the internal oblique and transverse muscles with 3 - 4 separate prolene sutures. In this case, the edge of the mesh should be located approximately 2 cm above the lower edge of the muscles. It is necessary to ensure that the nerves passing in this area do not get into the seam.

After that, the wide branch of the prosthesis is superimposed on top of the narrow one so that the spermatic cord is placed in the hole prepared for it, and is fixed together with a prolene suture.

The opening for the spermatic cord should not be narrowed more than 1cm in diameter. Both branches of the prosthesis, one on top of the other, are tucked under the aponeurosis of the external oblique muscle into the previously formed space.

The aponeurosis of the external oblique muscle is sutured edge to edge without tension. The diameter of the developing outer inguinal ring is irrelevant.

Benefits Hernia repair with plastic surgery of the inguinal canal according to the Lichtenstein technique are:

Hernia recurrence is observed only in 3% of patients who underwent hernia repair using a plastic polymer mesh

· fast recovery

Low degree of discomfort after surgery

The operation can be performed under local anesthesia

Disadvantages hernia repair with plastic surgery of the inguinal canal according to the Lichtenstein method:

Large hernias require more sutures, which increases the risk of nerve damage

The operation can last from 60 to 80 minutes

Complications

Wound infection

Hernia repair refers to a clean operation that does not require prophylactic antibiotic therapy. For many years, the use of nets was thought to increase the risk of wound infection. Detailed analysis recent years showed that in most cases this complication develops due to the use of multifilament suture material such as silk. A single intravenous administration of an antibiotic during surgery should be recommended, especially in patients over 60 years of age.

Seroma

Seroma - accumulation of serous fluid in surgical wound in the zone of "dead space" remaining in the tissues after suturing. Seromas also form after conventional hernioplasty, but more often after using the mesh, as a reaction to trauma and a foreign body. Seroma composition - leukocytes, erythrocytes, macrophages, mast cells, blood serum from damaged venous and lymphatic capillaries.

Typically, a seroma appears 3 or 4 days after surgery. In the operation area, a tumor-like protrusion appears without signs of inflammation, which makes it possible to fear early recurrence of the hernia. Fluctuation is locally determined, ultrasound confirms the clinical diagnosis of fluid accumulation in the wound canal area. In this situation, a conservative expectant tactic is preferable, the seroma completely resolves after 2-3 weeks. Puncture or opening the wound is meaningless, since it does not prevent the separation of serous fluid, but contributes to the inevitable infection of the wound.

Hematoma

This complication requires debridement of the wound by opening and draining it. Hemorrhages can be observed at a considerable distance from the wound, for example, on the opposite side. If bleeding occurs into the scrotum, drainage can be difficult due to the soaking of the organ tissue with blood.

Neuralgia

This complication, to one degree or another, is observed in 15% - 20% of patients who underwent hernia repair, in the form of pain, parasthesia, hypersthesia for periods up to 6 months after surgery. Signs of neuralgia include pain or burning sensation in the groin, loss of skin sensitivity in certain areas. The assumption that laparoscopic hernioplasty will reduce the likelihood of developing neuralgia has not been confirmed.

Method advantages

The main advantages of hernioplasty according to Liechtenstein:

Low risk of postoperative complications. A severe course of the rehabilitation period is observed in 2-4% of cases, in the rest of the patients the operation goes without consequences.
Less intensity of pain syndrome that occurs after the hernia is removed.
Reducing the duration of the recovery period. The person returns to their usual way of life within 8 weeks after the intervention.
Low likelihood of re-formation of hernial orifices and the appearance of discomfort in the late postoperative period.
Possibility of performing hernioplasty under local anesthesia. This is especially important for patients for whom general anesthesia is contraindicated.
Ease of execution compared to other hernia repair techniques.

Abdominal hernia symptoms, causes and treatment

Live healthy! Hernia hernia strife. (20.10.2016)

Inguinal hernia. What it is

Indications and contraindications

The operation is indicated in the presence of any type of inguinal hernia. Contraindications to intervention:

Individual intolerance to the anesthesia used during surgery.
Large hernias that involve nerve endings that can be damaged during surgery.
Diseases of the blood. Any operations are contraindicated for people with bleeding problems, such as hemophilia. No drug can stop bleeding, which greatly increases the risk of death from blood loss.
Chronic heart or respiratory failure. The operation increases the burden on the heart, which aggravates the severity of the disease.
Infringement of a hernia. When performing hernioplasty by the Liechtenstein method, the surgeon is not able to conduct a full examination of the missing organs.
The appearance of symptoms of an acute abdomen of unknown origin. In this case, an additional examination is indicated, aimed at identifying concomitant pathologies.
Acute intestinal obstruction.
Recently postponed surgical interventions in the pelvic organs. Performing a hernia repair increases the load on a given area of \u200b\u200bthe body that has not had time to recover.

Preparing for surgery

Preparation for surgery includes the following steps:

Examination of the patient. Involves holding general analyzes blood and urine tests, blood tests for latent infections and coagulability, ultrasound of the hernial contents and abdominal cavity, ECG, fluorography. It helps to determine the volume of the upcoming operation, to identify indications and contraindications.
Anesthesiologist's consultation. At this stage, the type of anesthesia is selected, the presence of allergic reactions to pain medications is determined.
Compliance with a special diet. From the diet, it is necessary to exclude foods that slow down intestinal motility and have an irritating effect - fatty, fried and spicy foods, flour and confectionery products, alcohol.
Refusing to take some drugs... 2 weeks before the operation, stop treatment with anticoagulants, which increase the risk of hematomas.
Refusal to eat 12 hours before surgery.
Purgation. For this purpose, an enema or laxative suppositories are used.
Preparation of the operating field. The patient removes hair in the groin area, performs the necessary hygiene procedures, puts on clean underwear.
Bandaging lower limbs... It is performed on the day of surgery to prevent venous thrombosis.

Technique

The procedure for performing a surgical intervention includes the following steps:

The setting of an epidural or general anesthesia.
Production of a skin incision. The surgical wound is 5 cm long and runs in the area of \u200b\u200bthe pubic bone parallel to the inguinal ligament.
Dissection of the underlying tissues. The surgeon cuts the subcutaneous tissue, fascia and external oblique muscle and the external opening of the inguinal canal in layers. The edge of the muscle is separated from the spermatic cord, which is captured by the holder.
Separation of hernial contents and its examination. At this stage, the viability of the missing organs is determined.
Return of organs to the abdominal cavity.
The imposition of the explant (mesh covering the hernial orifice). The first suture secures the mesh to the pubic periosteum, the next step is suturing the lower edge of the implant with the inguinal ligament. The last suture secures the edge of the mesh behind the spermatic cord.
Suturing the oblique muscle, applying a cosmetic suture to the skin. Installation of drainage to ensure the outflow of inflammatory fluid.

Live healthy! How to prepare for surgery. (12.09.2016)

Live healthy! Three tests before surgery. (23.09.2016)

Three types of anesthesia. Live healthy! (14.10.2016)

Possible complications

After an operation performed by the Liechtenstein method, the following complications may develop:

Decreased sensitivity of the groin area. Surgical intervention has a high risk of damage to the nerve endings responsible for the innervation of the pelvic organs.
Scarring of tissues located in the area of \u200b\u200bthe spermatic cord through the implanted implant. Promotes impaired blood circulation in the testicle, leading to atrophy and loss of endocrine function.
Damage to the uterine round ligament in women. It is accompanied by prolapse of the organ, the main symptoms of which are vaginal bleeding, problems with urination, severe pain syndrome.
Surgical wound infection. When bacterial infections suppuration and inflammation of the surrounding tissues is observed. In this case, the patient is administered antibacterial drugs.
Hernia recurrence.

Rehabilitation

During the recovery period, the following activities are carried out:

The introduction of painkillers and antibacterial drugs.
Limitation of physical activity. In the first weeks after the operation, it is impossible to carry weights, to make bends and sudden movements. However, doing simple exercises during this period is helpful. Walking is allowed the next day after the intervention. You can sit down no earlier than a month later.
Wearing a bandage. The device holds the implant in correct position, prevents the loss of organs. A hard bandage is worn for 2-4 months.
Compliance with a special diet. In the first days after the operation, they eat liquid and semi-liquid food. In the future, foods are introduced into the diet that contribute to the rapid recovery of the body - fresh vegetables and fruits, meat, dairy products, fish.
Spa treatment. The sanatoriums provide proper care for patients who have undergone surgery.

The essence of the operation

Stages of the

Indications and contraindications for the operation

Rehabilitation period after surgery

Positive sides

Disadvantages of plastics according to Liechtenstein

Liechtenstein plastic cost

Lichtenstein's operation for inguinal hernia

When resorting to the Liechtenstein method

Limitations and contraindications

Pros and cons of the method

Pros of plastics according to Liechtenstein

Cons of the operation

How is the operation going

Intervention stages

What happens after the surgery

Liechtenstein operation

Video: Oblique inguinal hernia hernia repair

Video: Operation Liechtenstein

Video: TAPP for recurrent inguinal hernia

Liechtenstein operation

Liechtenstein hernioalloplasty technique

Lichtenstein plastic surgery for inguinal hernia

How is hernioplasty performed?

Contraindications to surgery

Benefits of plastics according to Liechtenstein

Disadvantages of the method

Possible complications

Rehabilitation

Methods for surgical removal of a hernia: tension and tension-free hernioplasty

Hernioplasty using the Liechtenstein technique

Types of hernia repair for the treatment of inguinal hernia

Other types of hernioplasty

Recovery after hernia repair

The essence of the operation

Stages of the

Indications and contraindications for the operation

Rehabilitation period after surgery

Positive sides

Disadvantages of plastics according to Liechtenstein

Liechtenstein plastic cost

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Method advantages

Indications and contraindications

Preparing for surgery

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Possible complications

Rehabilitation

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