COMPLICATIONS OF THE TREATMENT OF INGUINAL HERNIAS IN THE POSTOPERATIVE PERIOD IN CHILDREN IN THE CITY OF VORONEZH

Full Text

Relevance. Pathologies of the vaginal process of the peritoneum are widespread in childhood. The most common among them is the inguinal hernia, which exits through the outer ring of the inguinal canal. The prevalence of inguinal hernias prevails among boys than among girls by 8-10 times. The accuracy of diagnosis at the present stage of development of medical science does not cause difficulties, however, the question of choosing surgical treatment in such patients remains open. Currently, there are 3 methods of surgical treatment of inguinal hernia: traditional inguinal hernia repair, video-assisted percutaneous (using a Tuohy needle) and laparoscopic herniorrhaphy [1]. In the practice of a pediatric surgeon, it is important to apply an individual approach to each clinical case diagnosed with inguinal hernia. » in order to select the most rational method of treatment.
Target. Choose a rational type of surgical treatment of inguinal hernia, taking into account all possible anamnestic and clinical features of the patient.
Materials and methods. Over the past 5 years, 1853 children with a diagnosis of "groin hernia" have applied to the Children's Clinical Hospital No. 2. Among them, 164 children were operated on by the laparoscopic method: 143 patients - by purse-string method, 21 - by needle methods. To most accurately determine the feasibility and relevance of this work, we identified 4 clinical cases (with postoperative complications) that accurately describe the importance of an individual approach in the treatment of inguinal hernias.
1. A 10-year-old boy with excessively developed subcutaneous adipose tissue and overweight was operated on for an inguinal hernia endoscopically using the purse-string method. However, on the 3rd day of the postoperative period, complaints were received about the resumption of discomfort in the scrotum. On examination, a recurrence of the inguinal hernia caused by the disintegration of the surgical site was revealed. On the video of the operation - errors are excluded. During the second operation (laparoscopy), a torn knot was found, the cause of which was the ingress of a filamentous part of the thread, which was the cause of the collapsed "pouch". When working with manipulators, the tool thinned the thread and it was this section that got into the knot.
2. A patient operated on for an inguinal hernia with a needle laparoscopic method, 2 months after the operation, turns to the Children's Clinical Hospital No. 2 with a complaint of a tumor-like formation on the side of the surgical intervention. Ultrasound revealed a cyst of the spermatic cord, the cause of which was a discrepancy between the production (hyperproduction) and the suction function of the vaginal process of the peritoneum. The cyst of the spermatic cord was eliminated on a repeated "open" operation.
3. A 7-year-old girl was admitted with complaints of a palpable mass in the area of the inguinal fold (the place where the needle was inserted into the abdominal cavity). The child is asthenic, without subcutaneous fat, so the node, which is located under the skin, bulged and was easily palpable, which caused subjective discomfort in the patient.
4. A patient, aged 11, was admitted with complaints of pulling pains in the groin area on the side of the operation. Earlier, 1 month ago, the patient was operated on for an inguinal hernia using the needle method. Analyzing the video recording of the operation, we concluded that at the moment of tightening the inner inguinal ring, there was a strong tension of the tissues in the direction of the inguinal canal. We also note that these complaints disappeared after 6 months and we attribute this to the fact that the peritoneum was stretched.
Results. The causes of relapses and complications of inguinal hernias can be completely different factors. It is not always possible to choose the most accurate method of surgical intervention, which 100% avoids relapses and complications. However, taking into account such factors as: age, gender, body constitution, weight, can significantly reduce the number of adverse effects in the postoperative period and choose the most appropriate technique.
Discussion. An individual approach is extremely important in the diagnosis of any pathological conditions, especially in children. Despite the large flow of patients diagnosed with inguinal hernia, it is important to keep in mind the possible adverse effects in the postoperative period and try to avoid them by more careful choice of the method of surgical treatment based on the anamnestic and anthropometric data of the child.
Findings. In the practice of a pediatric surgeon, when choosing a specific type of surgical treatment, it is necessary to take into account the age, body constitution and weight of the child, for the most rational and effective treatment.

About the authors

Nadezhda Sergeyevna Bakaeva

Voronezh State Medical University named after N.N. Burdenko

Email: bakaeva.2000@bk.ru
ORCID iD: 0000-0001-9897-2649
SPIN-code: 7221-8025

student

Russian Federation, Student st., 10, Voronezh, Voronezh region, 394036

Dmitry Aleksandrovich Baranov

Voronezh State Medical University named after N.N. Burdenko

Email: Mitargan_br@mail.ru
ORCID iD: 0000-0002-1300-8672
SPIN-code: 3307-1994
Russian Federation, Student st., 10, Voronezh, Voronezh region, 394036

Vsevolod Vyacheslavovich Novitsky

Voronezh State Medical University named after N.N. Burdenko

Author for correspondence.
Email: mitta-mitta@mail.ru
ORCID iD: 0000-0002-3370-3410
Russian Federation, Student st., 10, Voronezh, Voronezh region, 394036

References