İleri Yaşlı Hastalarda (85 yaş ve üzeri) İnkarsere İnguinal Herni Cerrahisi Deneyimlerimiz

Öz

Amaç Eşlik eden komorbid hastalıklar nedeniyle ileri geriatrik yaş (85 yaş üstü) hastalar ayrı bir öneme sahiptir. Çalışmamızda; kliniğimizde ileri geriatrik yaş grubuna inkarserasyon nedeniyle uygulanan acil inguinal herni cerrahilerinin sonuçlarını değerlendirdik. Gereç ve Yöntem Ocak 2011- Aralık 2019 tarihleri arasında kliniğimizde inkansere inguinal herni nedeniyle acil cerrahi uygulanan 85 yaş üstü 16 hastanın verileri geriye dönük olarak incelendi. Hastaların demografik özellikleri, komorbid hastalıkları, uygulanan cerrahi tedavi çeşitleri, hastaların hastanede kalış süreleri ve morbidite, mortalite bilgileri kaydedildi. Bulgular Hastaların 14’ü erkek, 2’si kadındı. Ortalama yaş 88 (88-94) olarak görüldü. Hastaların 12’sinde sağ, 4’ünde sol inkansere inguinal herni mevcuttu. 11 hastada komorbid hastalık mevcut olup, 3 hastada yoktu. 11 hastaya genel anestezi, 5 hastaya spinal/epidural anestezi altında herni cerrahisi uygulandı. 10 hastada ameliyat sırasında inkarserasyona sekonder iskemik bulgular gözlendi. İskemi mevcut olan tüm hastalara öncelikle sıcak kompres tedavisi denendi. Sıcak kompres sonrası 3 hastanın barsak kanlanması düzelirken; 7 hastanın barsak kanlanmasında bozukluğun devam etmesi üzerine ince bağırsak rezeksiyon anastomozu uygulandı. 9 hastaya greftli inguinal herni onarımı yapıldı (rezeksiyon oranı %43,8). Postoperatif 3 hastada atelektazi, 2 hastada yara yeri enfeksiyonu gelişti. Hastaların ortalama hastanede kalış süresi 8,2 (3-15) gündü. Postoperatif dönemde 2 hasta sepsis, 1 hasta ise pulmoner emboli nedeniyle hastalar kaybedildi. Çalışmamızın morbidite oranı %31,2 iken mortalite oranı %18,75 idi. Tartışma İleri geriatrik grupta inkarserasyon nedeniyle acil uygulanan inguinal herni operasyonları, yüksek morbidite, mortalite ve barsak rezeksiyon oranına sahiptir. Bu durumların önüne geçmek için inguinal herni tanısı alan ileri geriatrik yaş hastalara elektif cerrahi yapılmasını önermekteyiz. Abstract İntroduction Patients of advanced geriatric age (over 85 years of age) have a special importance because of comorbid diseases. In our study; We evaluated the results of emergency inguinal hernia surgeries performed in the advanced geriatric age group due to incarceration in our clinic. Materials and Methods The data of 16 patients over the age of 85 who underwent emergency surgery for incense inguinal hernia in our clinic between January 2011 and December 2019 were retrospectively analyzed. The demographic characteristics of the patients, comorbid diseases, types of surgical treatment applied, hospitalization periods of the patients and morbidity and mortality information were recorded. Results 14 of the patients were male and 2 were female. Average age was seen as 88 (88-94). Twelve of the patients had a right and 4 had a left incident inguinal hernia. 11 patients had comorbid diseases, 3 patients did not. 11 patients underwent general anesthesia, 5 patients underwent hernia surgery under spinal / epidural anesthesia. Ischemic findings secondary to incarceration were observed in 10 patients during surgery. Warm compress therapy was first tried in all patients with ischemia. While the intestinal blood supply of 3 patients improved after the hot compress; Small intestine resection anastomosis was performed due to the persistence of the defect in the intestinal blood supply in 7 patients. Inguinal hernia repair with grafts was performed in 9 patients (resection rate 43.8%). Postoperatively, 3 patients developed atelectasis and 2 patients developed wound infection. The average hospital stay of the patients was 8.2 (3-15) days. In the postoperative period, 2 patients died due to sepsis and 1 patient due to pulmonary embolism. The morbidity rate of our study was 31.2%, while the mortality rate was 18.75%. Discussion In the advanced geriatric group, emergency inguinal hernia operations due to incarceration have high morbidity, mortality and intestinal resection rates. In order to prevent these situations, we recommend performing elective surgery to patients with advanced geriatric patients diagnosed with inguinal hernia.

Anahtar Kelimeler

• geriatri
• inguinal herni
• inkansere

Our Experiences in Incarcerated Inguinal Hernia Surgery in Super-Elderly Patients (85 years and above)

Öz

Patients of super-elderly age (85 years and above) have a special importance because of comorbid diseases. In our study; we evaluated the results of emergency inguinal hernia surgeries performed in the super-elderly age group due to incarceration in our clinic. The data of 16 patients over the age of 85 who underwent emergency surgery for incarcerated inguinal hernia in our clinic between January 2011 and December 2019 were retrospectively analyzed. The demographic characteristics of the patients, comorbid diseases, types of surgical treatment, hospital stay of the patients, morbidity and mortality data were searched. 14 of the patients were male and 2 were female. Mean age of the patients was 88,07±3,22 years (85-94). Twelve of the patients had a right and 4 had a left incarcerated inguinal hernia. 11 patients had comorbid diseases. 11 patients underwent general anesthesia, 5 patients underwent hernia surgery under regional (spinal / epidural) anesthesia. Ischemic findings secondary to incarceration were observed in 10 patients during surgery. Hot compress therapy was first tried in all patients with ischemia. While bowel vitality was observed in 3 patients after hot compress; small intestine resection anastomosis was performed in 7 patients due to deterioration of intestinal viability. Inguinal hernia repair with prosthetic material was performed in 9 patients (resection rate 43.8%). Postoperatively, 3 patients developed atelectasis and 2 patients developed wound infection. The average hospital stay of the patients was 8,21±3,78 days. In the postoperative period, 2 patients died due to sepsis and 1 patient due to pulmonary embolism. The morbidity rate of our study was 31.2%, while the mortality rate was 18.75%. In the super-elderly group, emergency inguinal hernia operations due to incarceration have high morbidity, mortality and intestinal resection rates. In order to prevent these situations, we recommend performing elective surgery to super-elderly patients with inguinal hernia.

Anahtar Kelimeler

• Incarceration
• inguinal hernia
• mortality
• resection
• super-elderly.

Kaynakça

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