Results of Laparoscopic and Conventional Hernioplasty in Older Patients and Morphological Changes in the Tissues of the Inguinal Canal

Abstract

Objective: Comparative evaluation of the results of laparoscopic (LHP) and conventional (CHP) hernioplasty in older patients (OP) and assessment of morphological changes in the tissues of the inguinal canal. Methods: The results of surgical treatment of 88 OP with inguinal hernias were studied. The main group consisted of 53 (60.2%) patients who underwent LHP, the control group included 35 (39.8%) patients after CHP; among them 77 (87.5%) patients had primary hernias, and 11 (12.5%) – recurrent hernias. The age of the patients varied from 60 to 84 years. In the main group patients underwent laparoscopic transabdominal preperitoneal (TAPP) hernioplasty. In the control group, various types of plasty of the posterior wall of the inguinal canal were applied: autoplasty using local tissues, Bassini and Postempsky repair. Muscle, aponeurotic and adipose tissues of the inguinal canal were sampled for morphological examination. Results: For all studied parameters (surgery duration, in-hospital duration, duration of complete rehabilitation), statistically significantly better results were obtained in in the LHP compared with CHP (p<0.05). Although the differences in complications were not statistically significant (Cox F test: p>0.05), the higher number of complications and their later onset tended to be seen in the CHP group compared with LHP. In patients with small hernias, decreased density of muscle tissue with increased density of the connective tissue were noted, while in patients with large hernias, thinning of the muscle tissue prevail, with expansion of dystrophic adipose tissue observed in all cases. Conclusion: The immediate results of LHP in OP showed its higher effectiveness compared with CHP. Significant changes in the tissues of the inguinal canal found in OP indicate their decreased resilience and potentially delayed reparation processes. Keywords: Inguinal hernia, older age groups, inguinal canal, pathology, laparoscopic hernioplasty, conventional hernioplasty.