| Popis: |
Surgical repair of inguinal hernias still constitutes an unresolved problem, which has been brought up to date by the introduction of laparoscopic surgery as a treatment option. The objective of this study, based on 1332 "first-hand" hernias, operated by the same operator from 1979 to 1992, was twofold: -to determine whether Mc Vay's technique is suitable for simple hernias, -to prevent, by means of a technical modification, introduced in the middle of the study (1st January 1985), the development, which we consider to be frequently underestimated, of residual pain and long-term functional sequelae, which impair the results of herniorraphies. This modification consists of the deliberate dissection and preservation of all of the nervous network of the groin. The recurrence rate was less than 3%. Mc Vay's technique is perfectly suitable for external oblique hernias and direct hernias, which represent 90% of all hernias. On the other hand, very large hernias with abdominal wall deterioration or recurrent hernias, especially when the initial surgical repair appeared to be satisfactory, would be better treated by direct or retroperitoneal insertion of a prosthesis. Systematic complete nerve preservation decreased residual pain. The frequency of all forms of functional symptoms and pain was divided by a factor of 3. Minor symptoms, often minimal and transient, decreased from 24% to 8%, but, most importantly, major symptoms, discomfort on effort, persistent and disabling pain, decreased from 3% to 1%. The results were considered to be good or excellent in 96% of cases. |
