Simultaneous operation in a patient with recurrent varicosity and recurrent inguinal hernia in a one-day hospital. Case report

Introduction. Currently, despite the use of modern and high-tech methods of surgical treatment of patients with varicose veins and hernias of the anterior abdominal wall in the long-term period, relapses of the disease occur in 1.7-14% of cases. The combination of postoperative recurrence of inguinal hernia and varicosis is an infrequent type of multiple surgical pathology.

Case report. The article presents a clinical observation of a patient with a relapse of varicosis and an inguinal hernia, who underwent a total of three surgical interventions before admission to the clinic. Detailed ultrasound diagnostics made it possible to establish the cause of the relapse and develop optimal surgical tactics, taking into account the individual characteristics of the disease and the nature of previous operations. Taking into account the anatomical proximity and one-sided localization of pathological processes, the patient underwent a simultaneous operation from one access. A day later, the postoperative pain intensity was rated with a visual analogue scale at 4.2 scores, a patient administered analgesics to relieve pain within two postoperative days. Class 2 compression stockings were used for the compression therapy. The patient was discharged from the clinic in satisfactory condition the following day after the intervention, complaining of minor pain in the surgical wound area. The postoperative period was uneventful, without complications. Pain, restriction of movement were observed within 4 days after surgery. The sutures were removed after 7 days, the wound healed by primary intention healing.

Conclusions. The use of a simultaneous operation allows a radical correction of both diseases, to reduce the psychological burden on the patient, to improve the aesthetic result of the intervention, to avoid thrombotic complications and hernia infringement in the postoperative period.

1. Ivanov YU.V., Solov’yov I. A., Sharov M.B. Modern concepts of concomitant surgical pathology and simultaneous operations. Annaly hirurgii = Annals of Surgery. 2007;(4):17–20. (In Russ.) Available at: https://elibrary.ru/item.asp?id=9603250.

2. Samarcev V.A., Gavrilov V.A., Parshakov A.A., Kuznecova M.V. Simultaneous operations in herniology. In: Materials of the IV congress of herniologists “Actual problems of herniology”. Moscow, November 1–2, 2019. Moscow; 2019, pp. 101–103. (In Russ.) Available at: https://hernia-conference.ru/assets/тезисы_2019-финальные.pdf.

3. Chernookov A.I., Larionov A.A., Belyh E.N., Nikolaev A.M., Tokin S.A., SHevchuk R. I., Podkolzin E.V. Experience in the use of simultaneous operations in patients with hernias of the anterior abdominal wall and varicose veins. In: Materials of the IV congress of herniologists “Actual problems of herniology”. Moscow, November 1–2, 2019. Moscow; 2019, рp. 139–140. (In Russ.) Available at: https://hernia-conference.ru/assets/тезисы_2019-финальные.pdf.

4. Vyortkina N.V., Hamitov F.F., Lisitski D.A., Gulaev O.G., Cheldnev K.V. Clinical and economic aspects of simultaneous operations at elderly and senile patients. Klinicheskaya gerontologiya = Сlinical gerontology. 2008;14(4):5–10. (In Russ.) Available at: https://elibrary.ru/item.asp?id=11635906.

5. Lysov N.A., Leshchenko I.G., Supil’nikov A. A., Stolyarov S.A., Aleksandrov I.K. Simultaneous operations in geriatric surgery. Vestnik meditsinskogo instituta “Reaviz”: reabilitatsiya, vrach i zdorovʹe = Bulletin of the Medical Institute “Reaviz”: Rehabilitation, Doctor and Health. 2019;6(42):103–111. (In Russ.) Available at: https://readera.org/143172276.

6. Ermakov N.A. Zorin E.A., Orlovskaya E.S. Simultaneous surgical correction of parocolostomal, median incisional inguinal hernia. In: Materials of the first all-Russian congress of herniologists. Moscow, Оctober 27–28, 2016. Moscow; 2016, pр. 38–39. (In Russ.) Available at: https://herniaweb.ru/assets/тезисы_гс_2016.pdf.

7. Pushkin S.Yu. Simultaneous interventions in patients with median ventral hernia. Aspirantskiy Vestnik Povolzhiya. 2009;(7–8):97–100. (In Russ.) Available at: https://elibrary.ru/item.asp?id=13054561.

8. Shikhmetov A.N., Osin L.A., Pasychev A.A., Zadikyan A.M. Experience of surgical treatment of simultaneous pathology in gynecological patients. Ambulatornaya khirurgiya = Ambulatory Surgery (Russia). 2018;(1–2):64–71. (In Russ.) https://doi.org/10.21518/1995-14772018-1-2-64-71.

9. Olifirova O.S., Omelchenko V.A., Goncharuk G.V. Simultaneous operations in surgical practice. Vestnik hirurgii im. I.I. Grekova = Grekov’s Bulletin of Surgery. 2002;161(5):84– 86. (In Russ.) Available at: https://elibrary.ru/item.asp?id=23035917.

10. Kurygin A.A., Semenov V.V. Social and economic aspects of simultaneous operations on abdominal organs. Vestnik hirurgii im. I.I. Grekova = Grekov’s Bulletin of Surgery. 2016;175(3):100– 105. (In Russ.) https://doi.org/10.24884/0042-4625-2016-175-3-100-105.

11. Park H.S., Kwon Y., Eom B.W., Lee T. Prospective nonrandomized comparison of quality of life and recurrence between high ligation and stripping and radiofrequency ablation for varicose veins. J Korean Surg Soc. 2013;84(1):48–56. https://doi.org/10.4174/jkss.2013.84.1.48.

12. Orr N.T., Davenport D.L., Roth J.S. Outcomes of simultaneous laparoscopic cholecystectomy and ventral hernia repair compared to that of laparoscopic cholecystectomy alone. Surg Endosc Jan. 2013;27(1):67–73. https://doi.org/10.1007/s00464-012-2408-z.

13. Polynskij A.A., Kozlovskaya A.V., Krechko A.S. Quality of life and long-term outcomes of sergical treatment in patients with recurrent inguinal hernias. Zhurnal Grodnenskogo gosudarstvennogo medicinskogo universiteta = Journal of the Grodno State Medical University. 2015;(4):30–32. (In Russ.) Available at: https://elibrary.ru/item.asp?id=25278472.

14. Smirnov A.A., Kulikov L.K., Privalov YU.A., Sobotovich V.F. Recurrence of lower limb varicose veins. Novosti hirurgii. 2015;23(4):447–451. (In Russ.) Available at: https://elib.vsmu.by/bitstream/123/4475/1/nkh_2015_4_447-451.pdf.

15. Kapustin B.B., Mingazova G.F., Elkhov I.V. On the causes of recurrence of inguinal hernias after hernioplasty by the Liechtenstein method. In: Materials of the international conference “Difficult hernias”. Moscow, Оctober 30, 2012. (In Russ.) Available at: https://общество-хирургов.рф/upload/2012_11_30.pdf.

16. Burcharth J. The epidemiology and risk factors for recurrence after inguinal hernia surgery. Dan Med J. 2014;61(5):B4846. Available at: https://pubmed.ncbi.nlm.nih.gov/24814748.

17. Pisanu A., Podda M., Saba A. Meta-analysis and review of prospective randomized trials comparing laparoscopic and Lichtenstein techniques in recurrent inguinal hernia repair. Hernia. 2014;19(3):355–356. https://doi.org/10.1007/s10029-014-1281-1.

18. Chernookov A.I., Ramishvili V.Sh., Dolgov S.I., Nikolaev A.M., Atayan A.A., Belyh E.N. Modern strategy for the treatment of patients with relapses of varicose veins after endovasal interventions. Georgian Medical News. 2021;(4):26–33. (In Russ.) Available at: https://geomednews.com/ru/v313-april-2021.

19. Pavei P., Ferini M., Spreafico G., Nosadini A., Piccioli A., Giraldi E., Baccaglini U. Ultrasound guided foam sclerotherapy of recurrent varices of the great and small saphenous vein: 5-year follow up. Veins and Lymphatics. 2014;3(2):46–55. https://doi.org/10.4081/vl.2014.4655.

20. Gavrilenko A.V., Lyadov K.V., Sokolov A.L., Lucenko M.M., Vahrat’yan P. E., Kim E.A. Miniinvasive methods for the treatment of the recurrent varicosis. Hirurgiya. Zhurnal im. N.I. Pirogova = Khirurgiya. 2011;(3):32–36. (In Russ.) Available at: https://mediasphera.ru/issues/khirurgiyazhurnal-im-n-i-pirogova/2011/3/030023-1207201136.