THE MODERN CONCEPT OF GENESIS AND TREATMENT OF GROIN HERNIAS (LITERATURE REVIEW)

Over 20 million hernioplasty operations for inguinal hernia are performed worldwide annually. Inguinal hernias are in the lead, they occur 9-12 times more often in men. In women, femoral hernias are operated four times more often, and they are strangulated 40% more often. In herniogenesis, along with traditional predisposing and producing factors, much attention is paid to connective tissue dysplasia and decrease in the contractile ability of the abdominal wall muscles. An established opinion on the formation of hernias is through non-obliterated peritoneal diverticula in intrauterine growth retardation. A femoral hernia may be a consequence of the expansion of the femoral ring due to the upward tightening of the inguinal ligament after surgical treatment of the inguinal hernia. Small femoral hernias, especially, in obese patients are clinically difficult to diagnose. Ultrasound, CT, and MRI are recommended methods. Ultrasound has specificity of 94.5% and sensitivity of 81.5%, while MRI has specificity of 93.6% and sensitivity of 94.5%. Asymptomatic hernia is an indication for surgical treatment due to high risk of potentially lethal complications, especially, in femoral hernias. Mortality rate in women with strangulated femoral hernias is 3.8%, whereas after planned operations it is less than 0.1%. Among patients with inguinal hernias, 5.1% are operated on urgently for strangulation, while for femoral hernias, 28.1-40.5% are operated on urgently. Moreover, operations associated with strangulation are accompanied by a sevenfold to tenfold increase in the mortality rate. The likelihood of recurrence of the disease is lower after a tension-free plasty. There is a high percentage (up to 40%) of repeated operations, especially in women, for femoral hernia after previous inguinal hernia repair with local tissues. This is explained by either the lack of diagnosis of small femoral hernias during the first operation or by the use of tension technology in the anterior inguinal plastic repair. Today, the unification of inguinal and femoral hernias into a single classification (L. Nyhus, 1993; R. Stoppa 1998) is associated with the anatomical and clinical similarity of hernias in this zone. The main types of autohernioplasty of inguinal hernias are various ways to strengthen the posterior wall of the inguinal canal with its own tissues. The era of the use of mesh prostheses began in the late 1950s and has significantly reduced the percentage of relapses after open hernioplasty. The gold standard of this plastic surgery for inguinal hernias was Liechtenstein’s type I operation. Then the technologies of open preperitoneal, including those from the mini-access, transabdominal (TAPP - 1993) and total extraperitoneal (TEP - 1993) operations were developed. Laparoscopic TAPP and endoscopic TER plastics allow treating and preventing the occurrence of all inguinalfemoral hernia localization, closing the entrances to the inguinal canal and the femoral ring. The literature data indicate practicability of such approaches also in performing open prosthetic hernia repair of inguinal hernia.

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