The Comparison Of Elective Repair Versus Emergency Surgery In The Elderly Patients With Ventral Hernia

Year 2018, Volume: 32 Issue: 1, 15 - 21, 18.05.2018

Burhan Hakan Kanat Zeynep Özkan Mehmet Buğra Bozan Fadlı Doğan Fatih Erol Mesut Yur Kazım Duman Yılmaz Polat Selim Sözen Mehmet Burak Dal

https://doi.org/10.5505/deutfd.2018.08860

Cited By: 2

Abstract

Objective: With the increase in life span and expectancy, elderly
patients are more frequently encountered. Advanced technology and medical
applications enabled the elderly patients to be operated more easily and
reduced their morbidity and mortality risks at the same rate. We aimed to
evaluate the elderly patients who were treated electively and emergently due to
ventral hernia and to compare the outcomes of their treatments in this study.

Material and Method: The files of the elderly patients who were diagnosed
with ventral hernia in our clinic between January-2012 and November-2014 were
screened retrospectively. Thirty-eight patients aged 65 years and over were
divided into two groups as emergently (Group-I) or electively (Group-II)
operated patients. They were compared in terms of comorbid diseases (cardiac, pulmonary,
endocrine and other) and complications (seroma, wound infection, ileus and
others).

Results: Ten (26%) patients were determined as emergency (Group-I)
and 28 patients(74%) as elective surgery group (Group-II).No statistically
significant difference was found between two groups in terms of ASA values (p =
0.27). Of 31 patients (78%) with comorbid disease, eight (24%) were in Group-I
and 23 (76%) were observed to be in Group-II (p = 0.60). Of five patients (13.1%) who required intensive care
need, four (10.5%) were in Group- I and one (2.6%) was in Group-II (p=0.012).
Complication developed in nine patients (23.6%) and three of them (7.9%) were
classified as Group-I and six of them (15.7%) as Group-II (p = 0.44). Seroma
was found in three patients (7.9%) and one of them (2.6%) was in Group-I and
two patients (5.2%) were in Group-II (p
= 0.61).

Conclusion: Our study suggests that, in the future, non-operative
observation may be preferred compared to emergency or elective surgical
procedures for the elderly cases with asymptomatic incisional hernia.

Keywords

mergency, elective, ventral hernia, elderly

Yaşlı Hastalarda Ventral Herni Tamirinde Elektif Cerrahiye Karşı Acil Cerrahi Yaklaşımın Karşılaştirılması

Abstract

Amaç: Yaşam süresinin
ve beklentisinin artmasıyla yaşlı hastalar ile artık daha fazla
karşılaşılmaktadır. Gelişen teknoloji ve tıbbi uygulamalar ile yaşlı hastalar
daha rahat opere edilmekte ve morbidite-mortalite riskleri aynı oranda
azalmaktadır. Çalışmamızda, insizyonel herni nedeniyle elektif ve acil olarak
tedavi edilen ileri yaş hastaları değerlendirmek ve tedavi sonuçlarını
karşılaştırmayı amaçladık.

Gereç ve yöntem:
Kliniğimizde Ocak 2012-Kasım 2014 tarihleri arasında, insizyonel herni tanısı
konmuş ileri yaş hastaların dosyaları retrospektif olarak taranmıştır. Yaşı 65
ve üstü olan 38 hasta,acil ve elektif şartlarda opere edilenler olmak üzere iki
gruba ayrılmış; Acil cerrahi yapılanlar Grup-I ve Elektif cerrahi yapılanlar
Grup-II olarak belirlenmiştir. İki grup yandaş hastalıklar (kardiyak, pulmoner,
endokrin ve diğer) ve komplikasyonlar (seroma,yara enfeksiyonu, ileus ve diğer)
yönüyle karşılaştırılmıştır.

Bulgular: On (% 26) hasta
acil (Grup-I) ve 28 (% 74) hasta elektif cerrahi grubu (Grup-II) olarak tespit
edilmiştir. Anestezi Skoru değerleri açısından iki grup arasında istatistiksel
olarak anlamlı fark olmadığı bulunmuştur (p=0,27).
Yandaş hastalığı olan 31 (% 78) hastanın 8(% 24)’i Grup-I ve 23(% 76)'ü Grup-II
olarak görülmüştür (p=0,60). Yoğun
bakım ihtiyacı gösteren 5(% 13,1) hastanın 4 (%10,5)’ü Grup-I ve 1 (%2.6)’i
Grup-II olarak bulunmuştur (p=0,012).
Dokuz (% 23,6) hastada komplikasyon gelişmiş, 3 (%7,9)’ü Grup-I, 6 (%15,7)
hasta Grup-II olarak tespit edilmiştir (p=
0,44). Seroma toplam 3 (% 7,9) hastada vardı ve bunlardan 1 (% 2,6) hasta
Grup-I ve 2 (%5,2) hasta Grup-II olarak bulunmuştur (p=0,61). 

Sonuç: Gelecekte,
asemptomatik insizyonel hernili yaşlı olgularda acil veya elektif cerrahi
işlemlere kıyasla, non- operatif gözlemin tercih edilebileceğini çalışmamız
bize düşündürmektedir. 

Keywords

acil, elektif, ventral herni, ileri yaş

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