MPEMIEAHM PALOBU BIBLID 0370-8179, 131 {2003} 1-2 p. 82.91 BESTEH3MOHE IIPOLEYPE Y XUPYPIIKOM JIEYERDY TIPEMOHCKMX KUJIA Uparan J.MVWJIMA', Mipxo A.TIEJMh* 1. Xuepypunxa eaunnixa Kannnict Llenrap Hoan; 2. Xupypurko otemere Sapancrnente tenrtap Yate KPATAK CAJIPXKAL!: Yaynia mune nojasRHeaio MATEMKaNHIK xepHKia y ORpAcTO| noMynauHiM EapHPA on 10 po 15%. Onnoc myuxapaya Kena je 12:7. Mnunaenua Kon GonechnKa crapocta on 25 - 40 ron: no ce Kpohe wauehy 5 x 8% nox xon Sonechnka Crapuinx on 75 roana ona HsHOCK H NpeKC 45%. Foams ¥ CAL ce nasone snue on 700,000 onepawria npenovckix kana w ro je HajNewhe waeoheHa xxpypuiKa npo- eaypa y O80) seri. 3HaNajK HONDETUN Kj CY NOCTHFHYTH Y XHPYPUIKO] TexAM, KAO H YCMEWAH POsKO| HoBHx npoTeTcKix MaTEpHjana AOBENK Cy AO IHANO|HOr NOBOMWOHA HCXOAG ONEPATHBHOT SAxBATO KOA MHOTHK Gonecrinta. Osc noSonuian cy Hojevarveria y cneuNjon208aKWM YeHTpHMG 34 ONEPATHEHA TPETHGH KANG Kojn y Behusn cnyxojesa wMaiy crony peumAneuparsa mary oa 1%. Hacynpor osome crona pewenHed Kon Behirle ont xHpypra CCTOje WAGE aHANG|HO eHCoKG (no 10% 30 npHMapHe H nO 35% 30 peunAKaHe xepuuje). O80 va % 3HaMGjOX COUMCEKOMOMCKH CCNEKT CO NPOUEHENKA AKPEKTHAM H HHMpeKTHAM tpouxosnua y CAll og 28 wusnnjapau ROnapo Ha ronMUIHKeM HBO. 30 HOW JeMRy TOK NoAGUM Ha xaROCT He nocroje, Yenoctasnare auaronckor « ¢yHkuonontor warerpuTera TpGyWHOF 3Hna je CAPKG POsHOEPCHKK pexoH- crpynuvia weroehx nedexara. ¥ caspemavio] xupyprala npxmeriyie ce seu Spo) xupypuukixx meToAG H TexHv- ko. MaGop aaavc oA BenminHe, noKaMAZOUKje H EpCTe NEbEXATA TPGYLUHO ao KOO H IHOHG H BeUTHHE aupypra. Cee crannopane meTon® oneparveHor neveika KANG 2acHHBGIy Co Ha MehyCOGHOM CyTyPHpARY TkHEG Koja OGHsHO HCY y TOKBOM RPHHyRHOM GHATOMCKOM OAHOCY. Ono TaKO!}e HOPYLIGEG OCHOSHM XHPYDUIKA NpHUAN AO TRHEO HE Cacly HuKaA 6iTH NOR TeHaWjOM TO AOBOAK # HO BEMAKOF K HeNpHXEGTRMBOr Gpoja HeycneUIHHx nnrepscnuria. Edexrustija nprctya y pewascry oBor npoSiena je npaKeHa noTnyHOr OjavaBaKkG WHTs- HkanHor HoAG oBFOBOpOiyAum ExoMarepujonom (upexnye) ca ynorpeGOm 728. "tensionfres’ rexxuKe, Ono sHaNGjaH HanpenaK y xxpyprija xepryja sean je 3a Ushera kojx je 1958. roaune onucao oneparusny mpo- enypy 20 penapauniy xephuja Kopyctehn Mopneu mpexauy. Coe merone "Yensionfres" penapayvja wnranionuee Kana aaxTesaiy Nprweny mpexiue Bea oBaup wa NpACT- yn (oTBopeH npesteh, OT8OpeH aaKH KK NoNaPOCKONCKH 3o ycnewWan HoxoA PeKONCTPYKuNie MPEXMUAMG AEDMMUCANK Cy NPAMLUT XYPYPUIKE TexiMKe Koji CE MOPLIY ouronava (wpexdue ce cTasRaly COM HA anpase CrpYKTYPE TPEYWMOr sKAG YS WeroBy Npernemny ¥ noxrey ANCEKUMIy; 30 CYTYPADAHE MPEXHUE Ca vEHYaNG AEderTa, HojveWihe dactwia, Tea ynoTpeGna- BOTH jaKe CHHTETCKE HEPECOPNTHEHE KOHLIE CO GTPAYMATCKOM MTOM; NOjeAKHOMMK MN NPORYKHH WICBOBH annnunpaly ce Hon ws OR HaMLC rpampra a 2 em on vEMUe exberra}. Beatenawone npoueAype Cy H2y3CTHO CHFYpHE M eduKCHE MeTORE y TDETMAHY NPENOHCKME KHNO. ¥ NOKNEA- fee ase neuetinje umMpoKO cy npHxBaheHe y CeeTy TOKO AG AGHA 80% cevx penapauria y xepHHoROrHiy y BHCOKO PaBHjohHM 2ONCAHI JoMNaMG OTMOAG HA OBE METORe. AKO CE KOPEKTHO NPHKENE y2 GoUITOSAHe ‘OcHOBHI ADMHUHINA KOjH Cy REHMNCOHA y HOjEChiN XEPHHONOLIKHIK UEHTPHMG Y CAETY Roly CTOny PeUMAHAG marsy oa 1% Kreysne pose: Gezrenavone, apoyerype, npenowcka, kana yBOs, nor meptoneywa. Bpera xepH UDC: 616.34.007.43.089.23:611.96 ie onronapa KaLMHOM TIpesca najnpsxnahesnijoj aedbunnunin xepisnja npenera- bua nporpyanjy oprana Kpoa orBope y sHinosnMa Tene- cote myrimiHa y Kojiia ce oH Haase. porpysiia op- ana je Kamroraxst BaxkaH Aco sleq>uHHTEHe jep ce Ges thera ne Moxe nocrasirTn sujarHosa xepHe, Octionva anaronicxa KapaxtepucrHka aGqonmtaTHs. xepriia je nocrojatbe kntHor oTBopa x KiAHE Kece. Kita it oTbop je aewbexr y attloHeypoTHtaito-pactysjanHont tery ‘TpOytMMOT a1Aa AOK je KHLAHA xeca Hs6o™MMA Naprjeran~ Pag je tipuxaalen sa waltasrty 25.12.2002, 82 orpopy na aGor Tora Kitze noGitajy mse Mpesta cnojeet xasatn oTHOpHNA. Yaya wunitenia nojasnimarna maconAAAKN xep sua y onpactoj nonysranusjic BapHpa ost 10 slo 15%. Ox noc mymnkapana era je 12 1. Momomenat Kost Gome- cana crapocri on 25 ~ 40 romsnta xpehe ce assteby 54 8% OK KON GonecHIKa CrapHjMK os 75 roanta OM 11s Hoci i npeko 45% (1). SHasajiH HanpeTinT Koji ey uo crurseynit y xupypuixoj Text, Kao 1 yertet at paseo)CPIICKM _APXUB 3A LIEMOKYNHO SIEKAPCT8O HODHX mporercxtes marepujana onemt cy Ao sHavajuor noGomutatsa HExoja onepaTHBHOr 9axvaTa KO MHOTIK GonecunKa, Yenocrammaie astaromcKor # py MKuutonanior 1HTe- Tpurera TpGynIMor gHuMa je ewpxa pasMonpemiTx peKoH- epyxussia rseronix sledpexara, ¥ canpercenoj xupypragie mpunernyje ce nehn 6poj xupypusnstx Merona TeXHIIKa, WsGop aapnicit on nenwanne, oxamtsanaje H Bpere nede- xara TpOYLIMOr sitna Kao Ht sHaiba He BeUITHHE xHypra. Krys yortexa najGone je onpenso ser Ashly Cooper caojow osnarom certtenuiost: sHst jena Gonecr Koja je y nonteety aupyprije He saxresa TORHKO moswanamke aaToMje, piven xMpypmnke BeMITHHe, sHansa W KoMBxaNUja KAO iro je-To xepaiia y coun coojitw OG (2). MHIBHHAMHA XEPHHJA 13 MCTOPHJATA Hajpanujie samen 0 unranniansiin xepanjasca narupaiy 3 1500, ronnie npe Xpucra, Crapy Epms cy 6ieast 2060 yhosuarH ca uarnunannmt xeprijasa, a cave TepMiti Horne On Fpake pewnt Koja SHAME H9AAHAK, SaveTaK, HME aGounma, JarsicKa pew xepuntia osniavana pyntypy Hint neraibe. 3a KoHTpory Xepanjauasja, y TO Bpeste cy Hajue- ihe kopsunhett sanoju nat nojacesit. Celsus je ortcao onepantjy Koja ce cacrojara on MHUNSHJe Ha BpaTy ckPO- ‘TyMa Ca OMajarbeMt KIUTHEE Kece On cbyEITKyAYCA H meHN PeceHMparsemt NO cHonamtber MEIBKEANKO mpcrett. ‘Tectnc je ¥ ovo} onepanurjs ajesuhe 6xo yxnasan. H- uusuja ce Hajueuthe ocrasmana ornopenton. Kaci je npenopyunpana oGuMHa asratypa Kau Kece 1 dysHt Kynryca y wimpoy clomaumtner MpCTeHa KAO H H>HKOBA e ‘uysija sajeaMo ca TECTHCOM ANETATHO 04 aMaType, KAO ute je ro onncao Paul de Egine 700 roma mpe Hone pe Guy de Chauliac 1363. ronmre suhepertupa rm nanhy on dhemopanne xepmnje 1 ormicyje texnitKy aa pe- yxy crpanryaaunje, 1556, Pranco onneyje kopauthe- We YAMEGHEHOr HOUMA ga Heeltarse CrpastrymMpanor spara xepsje ys usGeranatse upena. 1559, Casper Crpo- Mayp oGjanayje OGHaraH yaxGeHHK O XepHnjanta y KOME taje pasmuixy naMeby supexTHX it HHApEKTHIX XepHHja W caperyje aa TecTHc He TpeGa sa 6yne yxaatban y TOK onepanuije, 3a pasnuny om zovaxamser mpuicryma, Tlowerkoss 19 seka anaTomja wursinane pernje 6rt a omitcavia H TaNHo Hed>HBtcaHa, Epa monepxe xupypri- je je movena 1865. rose xaga je Joseph Lister o6jani0 {cho} MeToM atrTHcence y3 HOMO KapGonnor pacrnopa 1a, 6x ce HenocpemHO HeKOMHKO romHHa KacHHje ojantiae npse amfavajue xupypunke npoueiype y Teparijn yt namiinx Kua (Marcy, Bassini), TIPETIOHCKA KHIIA TIpenrontcxe kite cy Hajtteuthe spcre xeprja. [locroje e- Koniko dhaxtopa pusiika Koj Aonoe Mo HACTAHKa Kep- aja: excntectinan uSHVKH Kanlop, ypohea caaGocr sate ummhwo-dhacnusjannine crpyxtypa mpenine-Gownor rp6y- IMF sina, atlaToMcKe anomatife, ToBpeste, onepatimsnt saxsarit, rojaskoer, Tpyswoha, M nepoxarHo Hajsarcenjt on eputx craperse, Tanac, Karta je mpocexit kHBOTHIE Dex osexa 74 roma, HuWieHItA Mojamosasamba xepriyja je 40%, y nopeteimy ca 5 % KonmKo je HaHociima Ha HowerKy ‘sor neKa Kajta je NPOCessNt IKHBOTHHL LEK HoREKA H9HO- eno 47 rosa. AHATOMHJA Murovniannic mirastent y cranapy 1 mje nutraerr, neh saKpuinmverta otha cTOGORHA Hoxtta musculus obliquus externus abdominis-a, koja ce mporexse ox teronor s10- ‘serka ca crnime romtaKe aarTepstop cytiepHtop Ta Cne {0 Hse- Fonor mpimnoja Ha TYGepKy AYA MyGHtKysty. Osa) antraneentt ce canisia nocrepopHo m cynepxopHo 1 dopspa HO} iarsnmantior xanata, Ha iseroHOM Mpiinojy sa tyGepRy- ‘TYM nYGHKYM BilaKHa MHToHUAAHION satTaneHTa ce MUMIpe y oGanKy Aenese, fa GH ce cHojiina ca NperHOM CrpauHort PeKTYCa, MITO MpesteTansa Momparmit jeo HATH: aranenta, Osa snaxita ce rakobe crtajajy ci waaxnusta MUTBUHIAAHOE AMFaMenTa cynporte cTparte, a ropHbo} paren nyGre kocri (lig. pubicum superior), upoaa- sit ropiey 1 mpemhy eTpaHy nySiaele KOCTH, HF ctlajajy ce ca mepnocrajysion: ny6itc-a 1 Ay MaMLIDKe Mpeta pastye cyreeptopy occuc ry6ue THe rpate ligamentum pectinenm Cooperi, Aponeuroza m. obl. ext. bopsenpa nperubit art suronnanHor kawata 1 pasanaja ce TpuaHrynapso mpeKo nyGwaxte KocTiC( cHlonauttbyr nperen } KPoa Kojn Mposaast faniculus spermaticus sua ligamentum rotundum. Bp pasawajaisa je ojavaH uetrepxpypanuniat paki, Caezeha ava enoja, musculus obfiqus intrenus 1 mu- skulus transversus abdominis, aysito mpenase mpexo cby- mutxyayea y maTepoMemtjaTHom emepy, ON HHHXOBOF HO- eTKa Ha HaWjasHOM rpeGeny 1 zaTepanKoM jemy HHCDN- ManHor mutramenta, 20. IHXOROF MpHTOja Ha Meth} TOWN pekTYCA, 1 MesUAjaMHo} Tpebrian werwIEAATHOT AAs rasettra, Ha ovaj sas bopsmpaly mpemtnye anit Aron anor Kaniana, y tnerono} AarepaHoj TpehIHK, Sow 1 Fonmamor Kata y cpenrsoj rpebitst 1.120 nocrepnop- Hor saa Kasiana y 1serono} scezujanno} tpehiens, Hora iowa musculus obliqus intrenus je wajeithe secwarea OK je werow AYIHH Mpenas npexo Kaxtana anoneypors- aH y FoprbHe enosusta, Hberona naan civtane HaAxONe a Gu oGyxnaritna cbynkyaye H dopaeripata m, crema- ster, Myexyno-anoneyporiciii ayk Koji ¢bopstpajy ova _nwa sumtha ce wasitma tendo konjuktivum, sar 1 axo ce ‘oa ba situmiha cnajajy canto na mpentsoj wn0%1 pexty~ ca. Jy6me on m. transversus abdominisa eH €H.10a60- Manama dhacttja, Heo dbacuije Koj je y KonTaKry cam. transversus abdominisom sasuba ce rpaxicnepsanna ¢pa~ ‘cunija, Ona nponasie tausoxe sa GH ce niojasitna 198 OWE Honute m transversus abdominisa x chopsinpa noctepnop- HH 31m MBITBHEHAMHOT KaxaMa. acrUja ce Mpritaja Ha lic nea pectinei w yaecrayje y Harpamst npemper sta ebe- Mopanie nnove, Flocne mpenaxcema strnimtanior mara ewra, Konnertsannja Tpantcnepaaane dpacturje ee Hamma namony6wse tpakr. Funikulus spermaticus, oxnocto lig, rotundum waaasic na petponepitroneannor npocrops pos yHYTpAMIDAC HATBHNAAHHE MpCreHs, Koja je stesutja- Ho st nibepuopao orpamisen KoHENaANLIjON TpaKcnep, saane chacturje, a narepanHo Ht cynepsropHo amoweypor KOM AOHOM HitKOM m, transversus abdominisa, Apre- puja ensiractpuxa iexbepHop mpenasr ori tenos Gavoxke senujanno} staiuus ysyrpauitser nperera. Jeo apancnepsamne cacunje Meanjanno on enracrpserinns, 83CPMCKM APXB 3A LIENIOKYNHO SIEKAPCTBO Chica 1. Muonexnumecnin opwdvuniyn cynona je nosnar xao Hasselbachov rpoyrao, Koji je mare Pano Orpantiven KPSHHIM CynosiENa, cymepHOpHO ttn0- HOM PeKTYCA HCA TEHRO KOIBYKTHEOM, a HHKhepHOpHO Murpyinamis anrasentos.. Mimapextua nntromnana Xepuija npoas# Kpos yayTpamnes mperen AaTeparno on, mmubepHopinix emHracTpHHI0< cysoBa, @ AMPeKTHA HH- rosmamia xepunsja, Memuijanuo on cygona, xpos Hassel- bach-on Tpyrao, rypajyhu tpastesepsanuyy cbacuny Ka Ha pen uum mponasehs xpos pacuien #a 180}. Masceby Tpax- cnepsante dpactinje # mephToneysa Hatasi ce co} BesAB- ‘On MenanHo je ynexen Tepaam smonexrsmeant opudpuiusiyst (MPO) Koja mpeacranma axatomcKo mpe- RUMEKIMOHO MECTO 9a HACTANAK AEANPEKTHE, AUPEKTHE i cbemopamme Kuve H mpencranma KaMeH TeMemam Y Ca BpemeHont pasyntenatby M pashoiy xepHHOTOTHe (CHK D, MPO je npoctop Kojn je orpaine4ert empena snraveiaa- HiME THITaMEHTOM a NOSAMM HAMONYGHYBHM TpaKTOM, Me- sutjanio cromanstbost meitiost m.rektus abdominisa 1 a- ‘Tepanko m.iliopsoasom. Toprsa rpaunaya je npenctanmena ayn snaxsusca m.transversusa abdominisa 1m, obli qus internusa a nora Cooper-onnat auramentom. MPO. po6uja y roptsem geay funiculus spermaticus a y josex desopanna apreprija i nena. MPO je samsruher camo ‘paricnepaainoss dbacigijom sist momyurrarwent 1 ca Smetwert uacraje xia (3). ETHONOTHJA Onunire je mpixnaheno say Hactanxy xepnja rnanay yno- ty aay TpH dbaxtopa : npucyerso seh oGmaxonante KiN~ He xece (mponecyc naruniamiic), mosehan mrrpaa6zon- aatn MpHTHtcaK 1 cnaGmetbe Nonttihia W TKHEKA Ca CTApE- went Caanpa ce aa je nepsuerestras nponecye parmsiaanc MpnwapHn yopox wacTanka HVOIpENTHHN HATDsEHARHOK xepiiyja, TpeGa unax peli ga wa Mexstsr MocTMopreM! He~ irrumanbnina Hajmarse 20 % ompacnx sta repanerenran, 84 mpouecye marianne a HMA 3a -KHBOTA HEY HATHA OM, nocrojaisa nrmiriame xepHije. Kox nocrojatka etopmiko BifcoKor HirrpaaGaosmtaa- or mpwricKa, KojM HacTaje Gino Gor Kauatba 6110 Gor Hanpesarba, aGroMMHANHIC s1AX Hajvemshe onpaKaBa ‘cnoj metTerpirrer ynpKoc MOCTOjasBY CAAGHX MECTA HA Ihe My. Oxo ce oGjaumtbana T3B. ,MexaEnaroM saTHApattA" Munthit a6nommnanior sia ce KoMTpaxyiy Ca HOIUE mem IeTpaaGqosoMiaTHOT MprrTucKa. Tana ce MyCKYAAp- IL AY Koji MpONASH MpeKo py HHEKYAYCA CHAPKIO KOHTPA- xyje H mpenasn npeso nournyror surenanHor aura MeiTa M TaKO LUTHTHE HlocTepHOpHN SH HHTBHHLAHEO Ka- nana omnocio Tpancepsanty dacuniy on dovehanor mmpurtucxa. ‘Tpetin dbaxrop Koji je ykmyyen y ernonorujy rari nazis xv, je cnaBrmetbe nerrantha i qpaciatja ca noneha- thea ToRHHa cTapocrit, Ca@tarpa ce sia aéHopmamHocTs ¥ Tpykrypu Konarena, sao mrTo cy pexyxtaja Tlomep ‘aor Konarena 1 na KOMHIEHTpaKIAje XHApOKeHTPOMEN MOFY nOBeCTH no CnaGOCTH KonareNEEX BraKAKA 36or NECA HacTaje cnaGoct npeniver TpSyLuHor s4uKa KIIACH@MKALHJA TIPETIOHCKMX KHIIA Bla 6x ynopebumaan espuxacuocr pasar serena y Pentapatunjic xepityia Heorixono je Hampi KAacHpisKa~ uuujy npertoncknx itn, Muore krtacixpuxauie ¢y npen- oxen TOKON nocnenibe 4 nenennie. arac ce ajyerthe puscersyje Nyhus-ona kacipukanja npenostexiex kiana . (Ona keracnepuekaupaja youora y oGanp Bemoumy yryrpa- uber Mperena i mierpsrrer sasuber soita HETRINIAANOF anava, TIpesca 080} kaneis utwaruijit ive cy enperane y cneaehe rpyne: ‘Hn |= tHMIpeKTHE KHME cA MOpMamTInNsE yRYTpA- uunisist mperestoxs ‘nun 2-uqupertue suire ca mpommpemen yayspa- lutsnes npcrewoss ‘rut 3a- anpertHe uerontsanHe xBLTES THM 36 - eiAMpenTHE KuHTe Ca craGouhy samiBer siura MHTBHANHOE KAKA; tam 3u = desopante xue; ‘rum 4 » cne ppere pentanunmax Kaun, ‘TPETMAH TIPEIIOHCKHX KH1A Puan oa onepanurje xeprnja je sartesapmatn, a cron pe uuinitea je, ako je penapauusja KopexsHO ypahewa, roniko ICRA, na TEHIKO 1a HOCTojx HeKIE pastor sGor Kora He 6H ‘onepricann cnaxy xeprmtjy, onMax tho EextOMt AIH)arHOCTH onary. Osa uinbeninta jour Bitte AOASH :t0 Haparkaia kaa yaneMo y oGaup MopOnaurer, Mopraartrer # nests Tony pertiumnba y cTyajeBnsa saniemapernix CTpanry: partioexepangja, crtemmtjantio y crapmitx mya ca mparehr MenimunickHat npoGrestesta, Crap ayant Yak TpeGa xa Gyay enekTuBHo onepucanit Gor THX Mpatehitx sei TOMCKINX cTaiba, a He Aa Ta Crarma MpexcraBMajy pasaer Gor Kora nehento onepricati. Rorhaek Madsen (5) cy nanecriumu 0 ceprss namutie~ Hara omepitcanitx s60r HHUA XepHIa KO KO}IKX je pens roxuna crapocti: Giina 84 roxune, mpi testy jeCPIICKM _APXUB 3A LIEMOKYNHO SIEKAPCTBO jena noarpyna enextiBiio onepucata, a apyra monrpyna je oneputcata yprentHo s60r crpantrynatuaje. ¥ omix Koj cy erextHBHO onepHcar, roma KommAHKanga je Guna 5 % ROK je KOR ONNX Kojnt cy OmepHICAHTE KAO xUITHHE cMya- jenn, Ta crona nsHocinta wax 57% ca cronose NoprantTe- ‘Ta 07 14%, Saxmysax je 6no 7a eneKTHBHa OTTepanLja Mo 2xe sla Gyne HaneeHa CHTYpHO, YAK Hy MpHcycTay os6uUn~ ix Koersuctapaiyhmx GostecrA, 0K ypreHTia pertapauin- ja xepitja Hoc PHSHK OX KOMILAAKaLUja MAK HY ONcy= cay Koersucrupajyhsex Gonecru. FanprenKo (6) je naBe- THO 0 cepijn on 260 crapujnx Ht CentmEEX naxusjenanra onepHcanHx enektitsH0 on MpenioncKe Kite, Tae je crona KoMMANKattja HsHOcHIAA 1,2 % M Ges MoprameTera, MPI. ‘esty je saxveyaio a je cHrypHo HonecTi enexTHBHy one- pany xepuuje y crapyjucx H cennaex namenjenara Hak 1. y npucycrny nparcharx Gonectu. Gardner (6) je y cbojoj ce- pitju naxarjentara crapusx o7, 80 rossi, omepitcamnx yp- TeHTHO H ETEKTHBHO OM MperoHcKHX KHIM YrBPAVO 7a Yapok emptit noreve y eho} mepy on mpumaprte Kosen.au- Kanuje came xepiiiie HeTO ox acomupamiex GonectH, u:TO _ykaayje Ha sinibeHMy a KaIMe y CrapHjHx Tpeda ontepnica- ‘THUnpe Hero urTo ce passniy KoMTTHKALNe. Meroxe a TextuKe pexoncrpyxituja, Koje ce saKac pumersyjy ¥ campeMmenio} xupypikoj mpaxcr, nonemeste yy tpw rpyme: A, Konsenumonanne mpouenype (Shouldice, Bassini we B, Enaockontexe nponenype (rpasicaGxosnmmama npe- nepuroneaia xepanopadja-TAPP, Torama eke~ ‘tpaneprtoneanna xepustopagpija-TEP 1 wsrepane- irroneanua onnay mecx rexsixa-IPOM), 1 U, Bes-rensntone (tension-free) mponerype (Lichten- stein, Gilbert, Rutkow.... BES-TEHSHOHE (TENSION-FREE) [IPOLIEJLYPE, Cue crantapatie metone onepariaHor aeverba Kitna aa- ‘campajy ce Ha Mebyco6xom cytypupamy TkHBa Koja 061 Ho wicy y TakBoxt mpHnynHOMt aHaTOMCKOM onHOcy. Oxo ‘Taxobe napyitiasa OcHOBHH XHpypmnKN MPHAIGIM 2a TKI ba He eMejy mutkamt Guta on TeNSHjo LTO jlOBORE IE NO BemnKor HeNpHXBATHBOT 6poja HeycneumHK HHTepB- enntnja, Exhextipanjst mpuicryn peruapaisa oxor npobine- Ma je MPuNetia NOTHYHOT ojavanamsa HETBKHARHOr Tosa onronapajyhuns SHosarepajanom (mpexiiue) ca ynorpe- Gom 738, ytension-free" rexrune, Ovaj sHaajant nanpestaK y xupypratju xeptuiia nesan je 3a 1958 rony Kasta je Us- her (7) onncao oneparimny nponeaypy sa penapannijy xepinsja kopucrebit Marlex xpexnmy. Keyna mpennoct one Merone je tT9 je ona nonoAra no emsennanje TeH- sue. Usher je orsapao samibnt 3H umrsiniannor KaKana i nocrasaao Marlex mpexsuy mcnon sedeKra. Taxo 10- crammeny Mpoximy je cytyppao Memujanto om wore aeexra ca jenwe 3a MATBHHaNMM mrameHT ca sIpyre crpane, Cue Metone ,tension-free™ penapanuse smararstan- Hunx KIWI saxtenajy NpUMeHY Mpextme Ges oGanpa ia puerytt (ormopex npentoxt, otopen saneox Hm Aanapo- exontcki). Ca ysoherben cbe koamrrerinix OHoMarepit jana y nponssoatsn mpexmua i rovoB0 ormyHor exist ucatba HIXOBH HeraTHBMIEX OCObHA, y HOCAEAE Be sleweHife Ro7asH No Mpanor ByMa y upsiMenn Ges TeHs110- smitx Texitixa y pentapatnyj Kita. 3a ono je HajostrowopHst- jw Lichtenstein xeprima mnscriryr y Jioc Anrenecy ojtt je y nepitoay on 1984 - 1987, ronnie mpomonucao opscsiant- ny stension-free” setoay xopsicrehit Marlex Mpexmiy on 3240 Gonecuntxa (8). Cne onepannrje cy reamenene y n0- Kanto} anecteatjt. Bonecimtin cy ormyurrenn sa Gnu Ne 118A AO MeTHHE Cara Haxox oepamnsje MHI HeMty cy ¥ nepuony mpaherba on jeitue so 8 rosutia yatame cnera 4 pe~ numsa (0.1%). Penartsn cy ce yrnanowt janiin y par Hos Tepxony MpHMeHe HOHE TeXHITKe Ht corm Cy ce TPH ‘mucari jour ne cresestost eKycTpy. Bes-TeHsioHe Mevone Haase CHE UMpy npHMeny y Xepitionornit jep je rocrano jacko 1a pexoxerpyxunie [eAHKHX mecheKara TPOYIINOK sna mUEPEKTHLHN MeTORANA pare Tpit weantka mpoGnesea: ~ TeUKa, @ HeKamt H HeMoryha, pertosmiusia ennciepit= pax oprasa, = Macranax pectimparopiiix st KUpKymApRE Hopeste figja yenen nonefiatea surpa-a6omustamsior mpitrit= ka ocne penoauusje oprasia y tp6yumny ayrmy y Kojoj cy #aryGumm cnoje ,wecTo Gopanka", 4 = Bennka yuecranocr peritina (1t 10 50%) a60r jaws caora TeHaHje Ha MecTHsta AUpeKTHOr ctiajarna erpy’- ‘Typa Tp6yumor oven, Koa pexoucrpyxunje nerpekara tpyuncor sipta sqpe- >xmtte ce MOTY NpMMetbUnATH Kao ,aaKprte" (patches), iAH, saanyusan (plages). ¥ oxtocy Ha crpyxtype TpOyinHor aikta MpexIMe ce anAMUMpajy Ha pasrmtsTiTHL MecTiMa, Hajseuthe npenteputoreanio 1 cyGanoxeyporiso ( lay grafts), pebe cySxyrano (on-lay grafts). Tloctasmatse Mpexnue y mpsoj nosinjit je HajGome jep muje y anpexrom Konrakry ca oprasiisa tp6yutne ty- ne, saurrihetia je ox chlomHe 1 yayrpauune naKbeKuje Mm cyncrutynute tpancnepsanny dhacuujy (Hajnarxruiy expyktypy TpOytior sista ca acnekra xepatorenie2e). 3a yereman Wexon pexoxcrpyxnuije MpexTHLANA e- uoanccant cy npumgiric xupyptuxe rexHue Koj ce M0- pajy nourroparit (pease ce crapmajy casio wa anpane ctpyktype 1pGynmor sivta ys merony mperaenay 1 m- >kanseBy ANCEKIUNY; 3a CYTYpHpare perme Ca HBHMAMA nedheka, Hajvewshe chacuarja, Tpe6a ynorpeSmavarit jaxe cimrrercke MepecopnTHBHe KOHIE ca aTpaymaTcKoM LHrmOM; ROFEAMTANHAC LAKE MponyAsH mraRODH AMAMELEPAR jy ce ma 1 cm on moan rpagpra a 2.cm on wore sedpeK ras Gan 1 anstensuje MpexHUe TPeGa sta onronapa nedheKTy ‘pOyumtor sila; NOcTaBrEAEGE BeMIKHX MpexHULa TPHME- Hont Geamane Textmake no Rives-y 1 Stopp-it (9) 1880,01 ce mutxonrat nocrasmarsent 1a 10-cm on MBH sedpexara Henton ostnha 11 acuta xa Gxt ce y Tost nonoxajy o,tp- 2xamit noMohy srpaaGnowmeanHor nprriicKa Ha OCHORy Pascal-onor saxon. Y npusertt je nehx Gpoj pasmrnrrux xepexnuta. Habop peat sackiisa ce Ha KpTepajyseisia Koj nportcrsey 13 wouxoBHNX ocoGrHEA ca jen CTPAMe, If BpeTe enTNTIe W aoKamsauje necbeKara TpOyunKor sHera ca Apyre Crpae Ha usGop yrituy 4 sttaise, ucKyCTBO H TpHTTAMHOCT Ost- Pebertoj 1ukomM xupypra Kao H HocryHHOcT Hojextue Ap- ‘cre Mpexxauxa onteparopy. 85CPFICKU_APXMB 3A LIENOKYMHO SIEKAPCTBO Cutercke mporese (sperxntye) Koje ce maxtae ynorpe- Gmanajy noqemene cy wa xepecopmtnane 1 pecopnTunite ao 1a Mpexacre H ninowacre (mHCTaCTE). Hepecoprrupie cunrercKe Mpexe luserente cy On Bra kava TepwonaGiuiMitx HlomMepa pasmirnitor Xewinjekor, cactasa, Hajueihe ce ynorpeGmanajy: = Mepenutetcka mpexka (Mersilene Polyester Mesh) xo- ja je uermnerewa out nonnecrapcKHx naakatia erxynenie Payuon-a 1 repemerxannny KHcemIHe. JeGrotHa joj je 0.254 mm, neosa je exact 1 capitrzutea. [ere- xa je ca mopama wnje cy wemieurtite 120 x 85 mm ca 06- AWKON fICKOBA = Marlex mpexka rineretta je of paaxatia nonynponyne- wa (Prolena). Ona sperka je taxobe Tartwa it Tana ca nopanca nemuntie 68 x 32 mm, “opusha je x xatbe enacritsna on Mepeitenicxe 1 Texe ce mpuzarohasa epapmist nospunnHant, ~ Pee ce ynoxpe6manajy neperse on nonyrerpadnyopo- cerxyaena (Teflona), nonisicinna (Ivlon Spounge) 1 momasnina (Naylon). 360r cnoje nopostte crpyKType ‘one mporese ce pajo MAKopnopitiy Y cycemHa TKH- na TpOyurnor arama, du6posHiea TKHBOM KOje BPCTO vypaera y ssnxone nope winehit H6posuy mao%y wit xantcyny. Hepecopnrienit cmttercxst rpacpron y oGanxy nzo%a (amcrona) cy KonmaxTHe TKAHHHe rAaTKHX MOBpULNtKa. BeoMa cy TAHKH, enACTHN, CABTAMBHE Ht nao pacTe- roto, Hajseuthe ynorpe6sbasant rpadpr oBe Bpere je tta- papmvett of ekcrtantanpanor rloaytetpadayopoerxynena (Gorotexa), Tparost ox oxor marepujana Kojrr nay one 6or0uIKe nepipomaxice BeoMa ce AKO PyRy}e. Mebyrine, a6or cnoje dpusiuke erpyerype Kojy kapaKre- piule oxcycrno ropa He HUKOpHOpHI ce y TKHIBA TPGY- uiMor awa weh ce camo nxaricynuuy 360r vera ce mopa- jy pero 1 tpajHo dukeHparH onronapajyhiar manitest Marepujanon, najGone ot Gorotexa, Hexocrarak ovis pagprona je tscona nitcoxa new Pecoprrisiin citirercku rparpronit ce He ynorpeGarta- najy 2a Tpajne paxocrpyxiunje ecbexaTa TpOyIIHOr sie Jep ce 6ps0 pasnarky H pecopSyjy y tRHBHOa Mocme Hate naarraunje, Hajsemthe naxon 3-6 nexema. YnorpemaBa- jy ce 3a npanpemeno sarsapaibe nedexata TPOyINOT 31 1a WAM y KONGrMatUjaMa ca HepecOpITHBHNEN HUME ayTO- TparbTousa 3a HxOHO ojasanaibe HOM Za 6H cnpestint HACTaHAK pendnts anxesnja y ONCYCTBY NepHTOHEYMA KOR, mnerviateranusje HepecopnTHBHAX MpeKACTIX CHHTETCKEK, rpabrona, Hajseushe ynorpeGaanat onakan rparpr je Ha- papmvent on naakana Vikrila (polyglaktina 910) rm Dexo- na (poliglaetic acid) Y ynorpe6n cy 1 xommosteri rpadyronit Koj cy cacTa sybetit On KOMGuHAKUH}a MpexacTax Vikrilnih rpadrowa 1. Mapaexc spexactixe rpadrova, Vikrilnih spexacrax, rpaprona at xyTie rpadprona x Vikril, Marlex 1 gox6ps.a- Hitx KapGorta KOH Cy jou YBek y cropamruHo} mpstceHt a yomemtan exo pexoncrpyxnpsja catrrercxi rpach- ‘TOBHMa Heoxontia je WHXORA MPHMEHA MOR MpaBHmHTIEN, MHANKaLjaNa Y9 ateKBaTHy oMepaTHDHy TexHHKy. Ha octosy ostex sisipennita Stoppa (10) je noctasito enexeha nnpapiina aa witxony npasitatty yriotpeby (Gorve je ynorpe- 86, Gmanans wpexacte on nmosacrux rparpronst; ynorpeGin- aTit MeKINE MPOKE KOA peRoHteTPYKIHja HepADHANE HOH: nia; o6po 4ckpojen' sperkactut sparpr tpeGa na npena- mBiiMe ecbeRTa RaNeKO Y smKpaABA TAHA Kost NMHTTAN runje: Kana ce sexmutarerupajy sao saxpme (patch-enmt) rpe- 6a na ce dpukeHpajy HepecopOTHsHHIN CHNTETCKHM MOKO- quaasenriois scarepujatom ys Mocrapmanbe iasout 0.5- 1 em ox weanta rpadprowa x snpannx crpyeTypa TPOyiNHIOT aia; KON HMMTLTAKTANLKje UHOBCKHX TIpoTesat Hf MpUNEHE GcamasHe Textke ten081t nporesa Tpeba pa Mpescattyiy smiane merbexata no 10 515 em y BepTHIKAHOas H XOPIOH- ‘TaMHOM Hpapuy; tparprone TpeGa wainazaetraparn tHpere- Pirroneanio 1 cyGanoxeyporieuso - y npocropy rite maj- Gone saerbyiy Tpantcnepsarthy dhactujys We TpeGa Hx yO ‘peGmanati y npucycTay sabexumje Hat Kon GonecHitKa ca cknonouhy Ka sutdpexienjckins KoserLaKanjanias Nps Mersupati najeTpoxe npHumte acerice) Muaarrasusja cittercisx rpadprona y Tkua Tp6y- mor a101a onoAK 20 HaCTaHKA xpowEKe uNehAaNKATOp- ue peaxtunje a crpaxo Teno, Hirrenrrer pearnarje sansten 7 GoxosmarnGuanocrH rpadyra 1 rKIE68 (11). Y mpouecy sapacrama pane xonasit no stukancymaruje Hxmnaanrara (pHGposHsIM TKHBOM KON MpHMeHe TOMA ne (anetactix ) rpadyrona sm x0 mKopropannie ¥ Tpyktype TPOyMIMOF srUtA TKHHIOM Koje ypacra Kpos Mpexacrnx rpadprossa Hajanrasajtnijn nexocranst onnx rparprova cy (12): ~ Crmapaibe HeAUKIX rpaxynOsa Y CAYYAjeDIEsKA Hp 2ketle peaxttje Ha crpaHo Teno Kost HEKIX GonectKa Gxeushe xox nsmaantranirie Mepenzenicxe stpexe), - Hacraniak mpepnnx anxeauja 1 uctyna Kom aMpeRT- Hor KoHTakra rpacpra ca opraniata TpGyntte Aytibe, - Hacranax nexbextuije Koje ce Moke caMMpATH CAMO ‘onerpariunaswen: rpagpra, = yuecranoer penuimmsa on 10-50% Koy BeAMTKHX HO- ‘cronepariimsnnx xepstja. rope BES-TEHSHOHE METOME Y PETAPALHIH TIPETIOHCKHX KHIA )Lichtensteinova upouegypa Lichtenstein (8) je 1989. rosie o6jannto na je 031 1984.10- AME CBE MPHMAPHE ANPEKTHE H HANPERTHE KIUTE KOM oxpacanx Tpernpao stension-free® reximKost Ges spe Hor saTBapatba sedpexra. Y piu on 3000 onreprreatttx ay ‘op je sa6enexuo cnera 4 peuiznia Koji cy ce javnitH y paHom nepHoay sanobetba Kone TexHKe 1 Koji ce MOTY npuenvicart jour HecTe eros neKycray. " MOCTERIDIX 5 10 aia ayrop wij sao Hjeran perusann. Hpor Manoa ¥ AOKaHO} aetecrestsit HY aMGynANTHE a. Koxka 1 norKoxkHO TKHDO Ce HMIISNPAjy ROK ce ano~ eypona m. obliqus externusa pacer tr oTHAp KAKO GH ce OTKPHO HHTBHHAAHN Kana. yrntKyAye ce ontbKE Ox 3: reer anima Katana, Kaomia Keca ce ocnOGaa H THeBArHEAIPA Matpar y aGnomeHt, Axo HlocTojr wenuxa suupexT#Ha KITA, Kuna Keca Ce MOE HABATHINNPATHE ARCOPHTHBHOS CyTY= pox, Koma nominpomWuieHcKe Mperke JMMEHSE ON OKO 8 x6 cm ce npumpentn Kao 6x oxronapana excrionNpaLtO} apejnt 1 Koja ce KopyteTit 3a peKOneTpYKIUy HEAOKYNNOF nog mursitiaaHor xastana Ges saTBapatba seibexna yr pana. Mpexraa ce cyTypupa yx cnoje noe mate rypa ceCPIICKM_APXUB 3A LIENOKYNHO SEKAPCTBO Conia 2. lichtensteinove nnoerke moka Hreiiansor xaMOnG nyGHANNE TySepKY, AaKYHAPHN AHTaeHT 1 wErenEATEL AMEaeHtT coe 0 19a YRyTpaLulber sIperewa x TO KONTINY- patio cytypom MonodwaamentHIM NOmINpoALHEKISL konues 3-0, Yuytpaunsa nox ce cyrypupa 9a pexryc raxobe KoHTitlyhpaitom cyrypoM nosunponuaenos 3-0. Toprea npr ce ca Hexonxo nojesueiasiix cyrypa cno- jt ca amoxeyposoM am sunusthent m. obliqus internusa, Cromia nottia speaame ce paceve Kako 61 ce Mora0 08 yxwarseri bynuixyaye y BHtcin ynyrpamntber npereta, 3a- ‘unt ce paceueait kpajesit mpexstome jean mpexo pyror 1 Mpiuspere sa mureitianHn smramen jeakom nomenpo- HIeHCKOM cytypoM. Oso oso NO cTHapatka HoROF yiytpatinser mpcresta (cama 2) Anonteyposa m, obliqus externusa ce norom pecyrypi pa na Mecry nenpex dytmeyayca, Ono je nornysa ,6ea- ‘Tensxona® (tension-free) pertapanirja Koja ne saxrena bopsaany pexonerpykutiy rtoxa kavana 2) Rives-ooa peaapayyja 3a pasauigy on Lichtenstein-one meroxe, Rives (9) npen- AWKE TacHparbe TOMKMpoNHTeHCKe MEIKE y Ay6DY pasait, uenton tpancnepsaane dhacupje, Tj. wsMteby He 1 nepuroneyia. Osa npowienypa saxrena mpecentaine tpan- ‘cwepaanue acttnje M Heo usApoxo ocnobabaise. Kopu- cri ce Behn noxpusay on mpexnte y Lichtenstein-onoj npoueaypit Jlorka wana ce cabitia y noexy mopy6a x dpitk- cpa cepijon nojenmaniaex cyrypa on Monodpitrastents- Hor nommpomnreia 2-0 sa neKTuHeani (Cooper-ov) anrasientt 13a daciitiy waana-y. Mpexnmta ce rata npo- nye retro dbyiieKyayca Ht mposman Hasse, emo ano- steypose m, transversusa abdominisa n unkenpa npexti- suis cyrypasra 3am. obliqus internus 5 naoyy pexryca (coma 3). Poprse-coonaunea spsaua ce pasanaja na 61t 06- yxnarivia ynmxyaye, a xpaun ce raxohe duxcupaly 2a sia nowenyra snuuitha, 3) Stoppa-uaa setoga Ona penapauuria je jenmietnena 1 goera pewoaysnto- Hapa y cBom Kowmenty. Kako je Stoppa (9) omtcio, pimuim ove Meroe je yekcTeHsHBHO MperercKo ofava~ Babe Tleputoneysia™ BeMNKOM AMIHOM Of yunopeHIX onMecrepexnx naakaa (sHaKPOH HIM MePCIUIEH) Koja ce swiacipa nssteby nepirToweysca HaxerepHopHor, NocrepH- opxor, mtubepopHor 1 aarepaminn aiigona a6xosieHa, pos nutexy cpenmutey aGnomunanny wixutaniy. Mpext- Camo 3. 8ves-o80 penopewria ua ce npoTexe OKO soHEer ABnoMeHA IL KapmaLe Ox jee Ao apyre crpaxe oGyxnarajyhn xomy nonominty napuie- ‘Tannor nepHToneysa ca Koji 360r KorIAreHOT HL OIL Hor TkHBa ToKOs apemetta Mlocraje suuKopHopuicasks. Ova xt npexcrasma BeaNKO MpoTeTCKo ojaabatbe Mepitrone: aator oMoraya Koje ra witint nomyHo Hepacrersarblit 1 TotnyHio KenozoHuM 3a xepaujanuly, Kpoa 6x0 Kojn axryeanit Wot noveHtsjam opsuprautiyss. Kana je Ko- PeKTHO ocrameHa, BeMitKa Mpextta Me aaxrena ATE jenatt aan 3a npituppunhitsare. Ona ce nprxn ma cuoM ste- cry nomohy Pascal-onor saxona xnapocrarckor mpuritcka, Gnerpaabaonenmanin spitiicak xeayiyhn npeko nepstro~ eamHor oMoTaya sApskH MpoTeay Ha cBOm secry). Ha ons) ayHH, npoTesa je OAMAX dbakenpana mi cHTTy a KACHHje 1 ojatatta ypacrartem oxkimntor TxMBa y Mpexdy. 4) Rutkow-2eoa xepruonnactinuxa 1993. rome Robbins i Rutkow (13) cy ‘ojuist pesyararusa Ha cepujat om 1563 xepanonaacraKa, Ha cBHM THHOBIINA XepHtHja, KAKO APHSLAPHHX TAKO H Pe- {UUIAMBHX pw vesty cy HAKaME crony peLEUKA of caso 0,1%. Kopnernan cy panste naputhe noxmponiuiencKe apexxuue (patch) ca verrost (plague) Koji cy mpasnim yMorapaibeMt spexine y KoUEeHH OG. Bentcuia seta Je mpunarohavana heme yayrpaunver nperenta seat eMMMHNH XepHujarHOr aeMbeKTa a y mexbeKT je yaaarien ppo ysaurji eo Yer, Mpexo ena nonunpomibrencKa Mpeasuta je Wtacupania na anreplopay ioupmncry 3an- er siiaa Kavaa, GesiuianHose TexmIKOM. Osa) rpadyr je ykpajant a osrovapa neni M1 OGAMKY WHEWHAAHOF anata ca pasabajaisem arepamHor ena Kako Gu ce a6y- xparuo dyniteyaye, Tocroneparupiit Gor je aratajio cwainen 360r MittiManne auceKuije 1 oxcyeTH TeHaIe, kao 11 360r Koputnherba emeuspamte avtecreati 5) Trabuco tesnuna Hona rexiinka xoja ce sactisa na sansiewatio) suscex unit 7kHA 14 zacHpay MoceBxEe Reh OBaIKORANE ceset- purge mperxitue Koja me mpanit NaGope H Kojy Huse No: ‘peGHo cytypupanic (sutureless preshaped mesh hernio-CPMICKM APXMB 3A LEJOKYNHO SIEKAPCTBO Canre 4, Trabucco-ea sutreless preshoped mesh xepnwonnactuca plasty) roxaaana ce nayserHo edhuKacHoM KaKO Y TPeTsta Hy MpusapHix Tako HY TpeTstany penmHBHIX KIUTA. 3a- cima ce Ha mpueny Ja je NonORHO ojavasarBe OMA ‘wnirnunianie kyraje’ (inguinal box) Kojx je mpema ayropy one Meroxe KOR BehitHe MymH TOTOBO HCH AHMEHIH aH sHoci 8 x5 cm. Texsixy je yneo ap Trabucco ca Trabuc- co Hernia uscrimyra y New Yorku, Toce6wa npeatrocr ‘one merose je urro mpexitny (Hertra Mesh) ratje orpes- Ho cytypupari Te y NlocromeparupHoN TOKY UMA MHOTO Marb Mpoulenar Heypanrija on Apyrx GesTensioMnx, npoueyp sje aren reaps Mpexnme y mim 6) PerFix Plug Kopniceu ce y penapanisjir anpexrie sc stiampexrite kH- ne npustesiom plug-a (ser) y oSauKy KHULOGpasta KOjH ce rnaachpa y yHY"pAULIbI HBMNATHN Mperet cyTyPHpa 3a oKonHO TeuHHO. Hekit ayropH cy MomicbKOBATH OBy evoay josaiyhit patch (saxpry) 3 ojavasaise xepxto- macrinxe (14). 7) Kugel patel Tloce6uioct one Metone je MpexHUA Koja Ha OGosy HMA oavame Koje MPOKIUY APAH PaBHlow H cnpewawa weHO pexaaniarse. ‘Opa Merona ce uas01M Kpo3 Maay uausHjy Henocpe; Ho HgHat yHytpaumser npcrenta, Tak BoM ACEKHEION ce ynasn y mpenepyroHeaniit npoctop rae ce nracHpa Mpeaiua Koja ce dpuxcipa sa oKOHO TKHBO jerIHOM TO} ntxanttom cytypom (15), Ona Merona Msta 9a MIT 18 3 TUTHTH YAyTpAUNEN NPCTEH M SMH IAI MMTBHEATHOY anlana Kao 4 dpeMopanisc Kanast 8) Prolene Hernia System (PHS) PHS je Merona Koja Kopicrit Hony tpoKoMmoxeTHy Mpeaximy Koja ce cactoj 13 onlay rpadpra (Kao xox. Lic: htenstein-ove panapanusje) # underlay rpadpra (Kao Kon, Stoppine nant Kugel-one penapansje) Koju cy mebyco6no noseaasit KoneKropoM. Anmoxeypoza m.obliqus externusa ce ormapa xpos mmutaxijy Ha mpertoxtt Y sYANHHE On 5 cm. Hao onuaaiba dbymmteynyca xpenpa ce mpenten npocrop, sa naacupatte ofinay rpadpra, Ako MocTojis KiomHa Keca ox ce miparuiupa xpos yaytpamney mmperen wasan y Tp6y- my ayrumy. Haxon Tora ce sranpuit vaceKnuja mpeneprt- Toweanor mpocropa (Borpoc-on npocrop) (16). Lena 88 Cro 5. Kugel patch Mpexkna ce novos acitpa Kpo3 seek Ha aazBeN 3 AY Hum kpoa yayTpantibat Mperent (cama 6). Underlay graft" ce naacstpa mperteprtoneaato vreaty ce of xaystaaHo mpoctpe 10 Cooper-onor mutta ‘a WHMe ce usTiErHt beMopamic Kanan, ,Onlay graft" ce uracotpa na samtbnt sin eIEmANAAHOT KAHAN H{CTION M06 iowyc exrrepuyca H mitTepHyca HE MpocrHpe ce ny Gepxyayn nyuxyma. ,Onlay graft” ce OKoMHO TxHBO cA TPH OjemuHAIHE cyTyPe (Jem ce Ho- pauper 3a craw wa nyGusuie ryGepKya, apyra Ha cpesHHT apKyca paviceepsyca # speha Ha cpeRiUt airunmanor ara setrra). Oynnxyaye ce oByxnari sacexcarse ,onkty" KON nonesre (16). AHECTESHJA Tlaniac ce wajuewthe Kopuerit nox wHeprerrparrista anlecreaitj 9a peniapanjy mnerascnantatx xepatija (17). Ta rugjen je 6yAaH 1 Moxke 2a capabyje TOKOM onepantie, uvnamweye une nosuesanses YMA, ¥ Wh nnapauue, ya cronpeMeno naGerasatne HocronepaTitoNOr sutckoscbopra Kojt ce jana nlocme ome anecrestfe, Ko vo cy Kattan 11 nowpabarse. Moxansea sqpiurtpatua je rajGomut meron sa awGynaropry xpypriiy y Kojo} matt- jewr vanyurra Gontuy scror jana (uHa4e ce TaKobe no cricke ewaibetbe spouskona ). Crmttanuta nai erneypanta yy TecTHMparsa pe auecresisa cy taxobe so6ap w9Gop. Enwaypanwa atrecre suja panmgxo noschana cnojy nonynapHocr. Hoxasano je Ja HeMa vemHKe pasminke y Kapzusjarom ,out-put"-y, cponsest aprepyjexonc npiTicky, yEyTMON nepitdhepHont lormopy x putrMy epita Kom rauWjenara KojH cy Bria y on rToj anecteanjit nas y pernonanom 6roKy. Pernouania anectesnija re avecreanjont 1 3Gor Marker nocronepaTinHor Gos (17) Tlawa npenwoct pernonane anecreste je TO AurTO maILi jenrr mone sa Gyste ormyunent HeKO: panuje, Tpe6a ncrahat qa vin attecreansje HeMta yrvttaa a cromy peusuna, KOMMAHMKALIHIE ¥ PETLAPALI)MA HHPBUHAMHHX XEPHHJA BESTEH3/MOHHM ME TOZAMA Penapaugrja xepunija Gestensnownse sypwa npoueaypa, ame Kao x cme oxteparnje 30 npahena omusrHac roi cremudbene KOTAK verona je A, Onwime xonsiauxanuje Onuite Kowmankansiie ykmyuyly nayhie arenentase,CPMICKM_APXMB 3A LIEMOKYNHO SIEKAPCTBO Conca 6. Mnacipawe PHS mpexnue nayhiic enGontioam, nxeysounje, tpomGodpresuric ypunapry perenuntiy (18). Behitta on sbirx woxe na 6yne HaGerkyTa slo6pos npeomteparunHioM nprerpestonc Ht pa~ ‘une ycvajarmenc a xpeaera. Cnamixt pastor ga rlocromepa~ ‘TuBRY ypuHapHy petenunjy je arouHKa HereNHja Ge- unke, Koja wacraje yenen mpenynanarta GeumKe Koje je sasnanlo HcyBHue eHTysujacriCsKIIM MpHeryMON anata ‘rynaa roxoM onepanije, KAO K NocKE te. B. Hoxaane ronanucayuje 1) Xemopazuja Exxstaoaa Korxe oxo miussuje je yoOusajesa. Tonexan -Mavia Kommnna KpoIE MOXKE Ja Ce Habe wy KOAH MeMHCa 1 cxporysta, Osa kps ce ancop6yje 1 ona Hecraje y ToKY He- koanxo gata. CkpoTansi xeMaromst Mory octuhi nent xe passiepe amit ce 1 OHH mpemetiont pecop6yly. TloweKax Wx je norpeGuo acmixpuparic unit xmpypunkH oxcrpansttit, 70 moweKan HHje moryhe, jep kpn usi6uGupa exporanta ‘TawBa, Perko obit xeMaToMM rlocraMy Hatpenpasi 1 ra- Xo Hacram aGcitec Mopa OHTH spextpan. 2) Moctonepatauena neypanzuja Hepsi osor perowa ce secro nospebyjy ToKox one- paunije 1ironmaminx xepaitja, Tnanmie nepait cy HAOXH= Horacrpiun, maKoHATBKHAMKH 5 reHHTOdeMopanti, ‘Tawanje terova reutrantia pana, TeoprjcKn enenaHo onu pea na 6yay cayynannt ToKOM onepannje, ami y npaxctt 70 Yecto Higje scoryhe. Honmoxmmoracrpisii Hepa ecto Guna tpancenmpan mpwrKom enevanie ropiber aucra anoneypose mt. obliqus externusa, Hnwonnrsitian- HC Hepa Moxke fa Gyae KeKILIAH MpHAMINOM MOGHAHSANIE- je gynmexynyca, a remsransa rpana remsrrorpestopanior Heppa sorke ma Gye mpeceena nprmnKoM exeitanije M. npesactepa (19). One mospene nsast0hajy pasmemre cre- ewe anlecresite win napecresuije y pernony cemopute mu- expa6yunje osx Hepana, miro Mponasit nocTe HEKOMHKO emtema Hamm mecent, 3) Hougienuaje pana Huchexaurja pave je jena on norexayjamnux pasnora ‘a penis xepune. ¥ cnenjansonanno yeraonasta 3a anGyaarophy xupyprajy etuuexenna nocromeparnsAnx nubextuyja pare usti0cH oxo 1% 3 atatbe, Y rutin Gon HiTaMa Mo2xe sa wapHPA H 0 5%. Onaxna cromia Bepo- Barto Hrje npava jep ce ewarpa ja je moro cha ant je noRaTaK Taka saTO MITO ce Beha onHK sHpeKzLTia ja- Broa TeK MocmE HavtacKA NaMrjeHITa Ha Gomme ma jeswHO- ‘crasio ie ysrasi y xapypuuky apxaay. Tipe ynorpe6e stpexcite xepraronaacrunna ce eaarpauna ‘mictoM npoutenypom Koja re saxtenana podiatry ky npimeny anmiGHotHKa, 360r soietna sa je mpi yno~ ‘rpe6ut GeatensHonx mpouenypa Honchast prsik Ox wa cTanka nntbekttje setorit xupypan cy upodpuaary puserbasamy antiGuoriKe, Kacunije je joxagano sa wa- cranak Hugexiyije npit npunenH Mpexiua tie noce- Tina npawexe caste Mpexnue neh mynnucbunasentHor usastor marepijara, MIpsatena wouodiianeniTHor tat nor Marepijana caariina je nojasy saxpexsusja (20) na, sttorst xxpypsie npenopysyiy mpusceny jenwe nepri- oneparuipne jose nedbaxoctopntia KOs GonectiKa KojH ce nogepravajy GestensHoHsss xeptmonzacraKanta 4)Cepom Cepom mpencrasma Konexuiljy cepysta y xupypunKo} part, Caapkst aeykoutre 1 neuro eprrpouirra, Bemtut- a KomeKinje AupeKTHO saBHicH oj OIceARILOCTH ZU4CeKL je teva 4 Mprsor npocropa Koji saoctaje y pam. Cepo- Mut ce weuthe japmsajy Kon Gesrensttonitx xepxitoparpatiasia ako 360r tpayMe Tkv8a Tako Hf 3Gor peakruje sa crpanto ‘reno (21). Ho npanitay ce cepox: janssa tpeher Hai wernp- ‘Tor HocTonepaTiHor saKta, OOHsIHO ce cepoxt pearicop- Gyje MaKot 2 70 3 nemteme 4 He Saxena HitkaKan TpeTMa, 3AKUBYIAK Besrenisnone nponerype cy HsyseTHo curypate 1 e¢prt ce Meroze y TpeTMaity mpenoncxtox xivra, Y nocacrbe ase jextetinje mittpoxo cy psixnaheute y cnery Tako a ae ae 80% cox pertapanitia y xeprtozorijt ¥ BIIcOKO pase Biijentsc sanaztHs semana OTMARA Ha OBE MeTORE, AKO ce KopexTHO Mphiatene ys MourTowasbe OcHOMEEX pI ra Kojt ey aedpinutcanit y HajveBitn: xepHnonOMIKHEN. Yen ‘Tpusa y cnery najy ctony peuiaima Marby 03 1% SIMTEPATYPA: 1. Lichtenstein IL. Hernia Repair Without Disability. St. Louis, Mo: Ishiyaku Eusoamerica Inc; 1986, 2, Nyhus LM. An anatomic reappraisal ofthe postrio Surg Clin North Am. 19645841306, 3. Nyhus EM, Condon RE. Hernia, 3rl ed. Lippincott; 1989:263-04, 44 Nyhus IM. A Clasification of Groin Henin. In: Arregui MB, Na ‘gin RF, eds. Inguinal Hernia: Advances or Comteoversie New ‘York, Radcliffe Medical Press, 99-102. 5. Bax T, Sheppant BC, Crass RA. Surgical options in the ma ‘ment of groin hernias. Am Fam Physician, 1999:59:893.90, 6. Gilbert Al. Inguinal hernia repair: biomaterials and suturekess re par. Perspect Gen Surg, 199132:113-129. 7. Usher FC, Cogan JE, Lowey TI. A new techuigque forthe repsie of inguinal and incisions hernias, Arch Surg, 1960;81:187-194, 8. Lichtenstein IL, Shulman AG, Amid PK, Mouttlor MM. The ten- sion fre heroplaty. Am J Sung. 19895157:188-193 9. Stoppa RE, Rives IL, Walaumont CR, Palot IP, Verhaeghe DJ, De Lntie. The use of Dacron inthe rept of hernias of the groin. Sarg, Clin Noth Am. 1984;64:2:269-285. 10. Schockett E, Routine rapid preperitoneal Marlex mesh but suns wall 89CPNCKM APXMB 3A LIENIOKYNHO SIEKAPCTBO all nguinal hernias. Contemp Surg, 1985:26:22-27 LL, Wantz GE, Prostheties: Their Complications and Management, Past I In: Bendavid Re, Prosthesis in Abdominal Wall Hernias ‘Austin, Tex: RG Landes Co: 1994:326-329, 12, Franconi G. Prosthetics: their complications & management. I Bendavid R, ed, Prostheses and Abdominal Wall Hernias, Boca Raton, Fla: CRC Press Ines 1994 13. Robbins AW, Rutkow IM. Mesh-plug hernioplasty. Surg Clin North Am, 1993;73:501-512, 14, Nyhus LM, Condon RE, Harkins HN. Cl preperitoneal hernia repair forall types of hernia ofthe groin. Ana J Surg, 1960;100:234-244, ical experiences with TENSION-FREE PROCEDURES IN THE TREATMENT OF GROIN HERNIAS Dragan J.MILIC ', Millko A. PEJIC’, 1. Surgical Clinic Clinical Centre Nis; 2, Surgical department Health Centre Uzice Hernie repair is one of the most common surgical procedures performed in the United States, with 700,000 operations performed each year. Improvements in surgical technique, fagether with the development of new prosthetic materials and a better understanding of how to use them, hove signif cantly improved outcomes for many patients. These improve. ments have occurred most notably in centers specializing in hernia surgery, with some insitulions reporting failure rates of less than 1%. In contrast, failure rates for general surgeons, ‘who perform most hernic repairs, remain significantly higher. This has important socioeconomic implications, adding on estimated $28 billion or more to the cost of treating the con- dion, based on calculations utilizing conservative estimates of failure rates and the average cost of a hernia repair Success of groin hernia repair is measured primarily by the permanence of the operation, fewest complications, minimal costs, and earliest reluen to normal ectivities. This success depends largely on the surgeon's understanding ofthe cnato- my and physiology of the surgical crea as well as a knowk. edge of how to use most effectively the currently available techniques and materials The most important advance in hernia surgery has been the development of tensionfree repairs. In 1958, Usher described ‘hernia repair using Marlex mesh. The benefit of that repair he described as being “tension-liminating’ or what we now call ensiorlree". Usher opened the posterior wall and sutured a swatch of Morlex mesh tothe undersurface of the medial mar gin of he defect and to the shelving edge ofthe inguinal igo ment. He created tails from the mesh that encircled the sper- matic cord and secured them to the inguinal ligament Every type of tensionfree repair requires a mesh, whether i is done through an open anterior, open posterior, oF laparo: scopic rovte. The most common prosthetic open repairs done today are the Lichtenstein onlay patch repair, the PerFix plug cand patch repair, he Prolene Hernia System bilayer patch repair and Trabucco's sutureless preshaped hernioraphy. General surgeons today have access to a wider and more sophisticated range of synthetic biomaterials for use in hernia repair than ever before. The advantages and disodvantages of each of these devices must be understood, however, before surgeons select any of these implants Meanwhile, a 1997 study of various biomaterials used in 90 ebdominel wall hemia repair further reported thatthe risk of infection, seroma formation, biomoterialreloted intestinal obstructions, and other complications can be minimized or liminated by understanding the process underlying these problems and toking proper precautions. The surgeon's choice of the prosthesis used in hernia repair is based on a combination of factors, including patient charac teristics; clinical experience, training, interest, and skil; under stonding of the ronge of products available and the clinical studies that may have been performed on each; and the sur geon’s familiarity with @ parliculer product and/or surgical opproach. Innovations in technique and product design will no doubt confinve to spur advances in hernia repair, and it is hoped, that they will continue to improve outcomes. The availabilty of these outcomes data, along with the ongoing accumula tion of clinical experience with a broad range of materials ‘and techniques, will help surgeons to better identify the most ‘appropriate prosthesis for the clinician and the patient It appears that herniclogy will remain inthe realm ofthe sur {geon, since it is doubiful that any medical measures will replace the operative treatment for abdominal wall hernias Although operative procedures are not yet ideal, important advances have been made in hemiorthophy resulting in improved outcomes: The use of local techniques has maxi rized the safely of anesthesia; lime needed for care has been minimized, with most procedures now being done on con outpatient basis; and better instruments and prosthetic devices have dramatically improved patient outcomes. However, @ greater appreciation for the vulnerability of the entre myopectineal orifice - and the secondary effects of localized mesh grafts - is necessary to ovoid ialrogenically created recurrences. An increased awareness of these factors by both general surgeons and hernia specialiss alike will improve results for all patients undergoing hernia surgery. Key words: tensionree, hernioraphy, groin, hernia Dr Dragan J. Mili Hirurdko Klinika KC Nis Bulevar Neinanjiéa 720/25 18 000 Nis email: dmilic@pit yuCPIICKM_APXMB 3A LIEIOKYMHO SIEKAPCTBO 15. Kugel RD. Minimally invasive, nonlaparoscopie, preperitoneal, and sutureles,inguisal herniorshaphy. Am J Surg. 1999; 302, 16.Gilbert AL, Sutureless repaie of i 19925163:331-335, 17. Young DV. Comparison of toca, spinal, and general anesthesia for ygunal herniorshaphy. Am J Surg, 1987:153:560-563. 18. Amid DK, Shulman AG, Lichtenstein IL. Careful sceutiny of the ‘open tension fes" heenioplsty. Am J Surg. 1993165:369-371 guinal hernia. Am J Surg 19. Starling JA, Harms BA. Hioinguins,iohypogastsie and enito-e moral neuralgia In: Bendavid R, ed. Prostheses and Absloial Wall Hernias, Austin, Tex: RG Landes Co; 19942851356. 20. Gilbert Al, Felton LL Infect nal hernia sepaie consi ring biomaterials and antibiotics, Surg. 1993:177:126-130. 21. Bendavid R. Seromas and prostheses, Part I. In; Bendavid Red Prostheses and Abdominal Wall Hernigs. Austin, Tex: RG Lands (Co: 1994:367-369 maccol Obstet. oL