Comparison of laparoscopic and open techniques in the treatment of inguinal and femoral hernia

Hernije jesu protruzije peritoneuma sa ili bez trbušnih organa odnosno njihovih dijelova kroz nasljedno ili stečeno oslabljeno mjesto u trbušnoj stijenci. U hernije ingvinalne regije spadaju direktna i indirektna ingvinalna te femoralna kila. Liječenje ingvinalnih i femoralnih hernija u pravilu je kirurško. Kirurške tehnike liječenja mogu se podijeliti na otvorene tehnike s napetošću i bez napetosti te na laparoskopske tehnike. Među otvorene tehnike s napetošću ubrajaju se Bassinijeva, Shouldiceova i McVayeva tehnika koje se, unatoč nekolicini jakih zagovaratelja, polako napuštaju. Zlatni standard u liječenju hernija je upotreba polipropilenskih mrežica, odnosno metode bez napetosti poput Lichtensteinove koje su jednostavnije i smanjuju broj recidiva. U današnje se vrijeme sve više okreće i prema laparoskopskim metodama liječenja hernija ingvinalne regije u koje spadaju TAPP i TEP pristup koji su značajno skuplji i kompliciraniji od otvorenih pristupa, ali pružaju bolju kvalitetu života pacijentu. U odabiru između otvorene i laparoskopske metode liječenja, kirurg mora u obzir uzeti značajke pacijenta, hernije, ali troškove operacije te vlastita ograničenja. Kako bi se poboljšala kvaliteta kirurške skrbi potrebno je ulagati u opremu i edukaciju liječnika te oblikovati zahvat prema potrebama i karakteristikama pacijenta.Hernias are protrusions of the peritoneum with or without abdominal organs or their parts through an inherited or acquired weakened place in the abdominal wall. Hernias of the inguinal region include direct and indirect inguinal hernias and femoral hernias. The treatment of inguinal and femoral hernias is usually surgical. Surgical techniques can be divided into open tension repairs and open tension-free repairs as well as laparoscopic techniques. Open tension repairs include Bassini’s, Shouldice’s and McVay’s techniques which, despite several strong advocates, are slowly being abandoned. The gold standard in the treatment of hernias is the use of polypropylene mesh, i.e. tension-free methods like Lichtenstein's that are simpler and reduce the number of recurrences. Nowadays, an increasing number of surgeons are turning to laparoscopic methods for the treatment of inguinal hernia such as the TAPP and TEP approach, which are significantly more expensive and complicated than open approaches, but provide a better quality of life for the patient. In choosing between open and laparoscopic methods of treatment, the surgeon must take into account the characteristics of the patient, of the hernia, but also the cost of surgery and their personal limitations. In order to improve the quality of surgical care, it is necessary to invest in the equipment and education of doctors and to design the procedure according to the needs and characteristics of the patient