Author/Editor		Škapin, Stojan
Title		Laparoskopska hernioplastika
Translated title		Laparoscopic hernioplasty
Type		članek
Source		Endoskopska revija
Vol. and No.		Letnik 2, št. 3
Publication year		1997
Volume		str. 43-6
Language		slo
Abstract		Background. Bassini is acknowledged to be the father of modern hernioplasty. The main drawback of his operative technique is that artificial approximation of tissue layers leads to strain at the suture line and accounts for high incidence of recurrence. New techniques which have eliminated tension on the line of repair and are associated with notably reduced recurrence rates and shorter and less painful recovery have been gaining popularity. Methods. From JUne 1993 to November 1996, 80 patients with inguinal hernia were operated on by the transabdominal preperitoneal approach. Closure of the hernial defect was accomplished with a 10x12 cm polypropylene mesh. The peritoneum was closed by continuous suturing in half the patients and using endoclips in another half. The patients returned for follow-up examination at 14 days, and at 3 and 6 months after surgery. Results. A total of 85 herniplasties have been performed at this Department. In the initial half of cases, the recurrence rate was 11.5%, while in the whole series it dropped to 4.5%. One patient required laparotomy for control of bleeding from the venous plexus. Other complications included 2 seromas, which were treated by aspiration, and one paralytic ileus. The overall complication rate was 9.3%. Conclusion. Bassini's hernioplasty is being slowly but steadily replaced by new tension - free techniques. With the exception of Lichenstein's approach, the new operations are technically more demanding and require considerable competence and skill in endoscopic surgery. By strict adherence to the adopted principles and through judicious selection of patients, the present recurrence rates can be reduced to the minimum.
Summary		Izhodišča. Obdobje moderne hernioplastike je utemeljil Bassini. Pomanjkljivost njegove metode je v nasilnem združevanju tkiv, kar vodi v previsok odstotek ponovitev. Breznapetnostne metode se uveljavljajo zaradi nižjega števila recidivov, predvsem pa zaradi hitrejšega in nebolečega okrevanja. Metode. S transabdominalno preperitonealno metodo smo od junija 1993 do novembra 1996 zaradi ingvinalne hernije operirali 80 bolnikov. Kilna izstopišča smo obskrbeli s polipropilensko mrežico 10 x 12 cm, peritonej smo pri polovici primerov zaprli s tekočim šivom, pri drugi polovici pa s sponkami. Bolnike smo kontrolno pregledali po štirinajstih dneh, treh in šestih mesecih. Rezultati. Skupaj smo opravili 85 hernioplastik. V prvi polovici smo imeli 11,5% recidivov, v celotni seriji pa 4,5%. Pri enem bolniku je bila potrebna laparatomija zaradi krvavitve iz venskega pleteža. Punktirati smo morali dva seroma, opazovali smo en paralitični ileus. V celoti smo imeli 9,3% zapletov. Zaključek. Bassinijevo herniopalstiko postopoma, vendar nezadržno zamenjujejo breznapetostne metode. Nove metode, razen Lichensteinove, so tehnično zahtevnejše, ker zahtevajo od kirurga obvladovanje endoskopskega načina operiranja. Z doslednim upoštevanjem načel in s skrbnejšo izbiro bolnikov je mogoče odstotek ponovitev zmanjšati na najmanjšo možno mero.
Descriptors		HERNIA, INGUINAL SURGERY, LAPAROSCOPIC