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Minimally Invasive or Open Inguinal Hernia Repairs - Immunological Results

V. Kyosev, E. Vikentieva, D. Popova, R. Vladimirova, E. Naseva, V. Mutafchiyski, K. Vasilev, P. Ivanov, D. Grigorov, D. Kotashev, G. Popivanov, V. Hristova, D. Penchev, H. Petrov


Introduction: The minimally invasive technique has replaced the open approach in many surgical procedures. The advantages and disadvantages of open and minimally invasive hernia surgery are still being discussed. This study compared postoperative immune changes after minimally invasive and open repair in patients with inguinal hernias (H-patients).Materials and Methods: The study included 36 male patients with inguinal hernias. Eighteen underwent minimally invasive hernia repair (Hm-patients). The mean age of the Hm- group was 52.4 years (18-73). The remaining 18 patients underwent open hernia repair (Ho- patients). Their mean age was 56.7 years (29-81). Blood tests were performed 24 hours prior to surgery, and 24 hours and 7 days after surgery. The analysis included full blood count and markers of inflammation (CRP, ESR, Fibrinogen). T- (CD3+), B- (CD19+) and NK-cell lymphocyte populations were studied by means of flow cytometry, as well as activation of leukocytes, according to the expression of HLA-DR, CD38, CD279, CD163. All data were analyzed using SPSS version 21.Results: 24 hours after surgery, there was a significant decrease in the monocytes and the NK- cells and an increase in the number of leukocytes, lymphocytes and granulocytes in the minimally invasive group compared with the open group. This difference between the two groups didn`t exist on the 7th postoperative day. Activated granulocytes (CD64+), monocytes (CD64/CD163+), T- lymphocytes (CD3+) and B-lymphocytes (CD19+) had a significant decrease in the open group compared with the minimally invasive group on the first postoperative day. On the 7th postoperative day, there was a significant increase in the markers of inflammation (CRP, ESR, Fibrinogen) and a decrease in the erythrocytes, the hematocrit and hemoglobin levels, NKT-cells, CD3+ and %HLA-DR in CD19+ in the open group.Conclusions: Minimally invasive inguinal hernia repair is a technically feasible option with lesser degrees of immunosuppressive response to open repair. Postoperative immune and blood parameters under investigation, are better preserved in the minimally invasive group.


Keywords: minimally invasive inguinal hernia repair, immunosuppressive response



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About The Authors

V. Kyosev

E. Vikentieva

D. Popova

R. Vladimirova

E. Naseva

V. Mutafchiyski

K. Vasilev

P. Ivanov

D. Grigorov

D. Kotashev

G. Popivanov

V. Hristova

D. Penchev

H. Petrov

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