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

Yıl 2021, , 485 - 489, 13.09.2021

Murat Kartal

https://doi.org/10.20515/otd.912572

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

Destekleyen Kurum

yok

Proje Numarası

yok

Teşekkür

yok

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.

Proje Numarası

yok

Kaynakça

• 1. https://www.nufusu.com/turkiye-nufusu-yas-gruplari
• 2. Matsuo M, Tazawa K. Reference range of clinical blood tests in physically independent patients of advanced age with groin hernia in a Japanese hospital. Geriatr Gerontol Int. 2019 Aug;19(8):780-785. doi: 10.1111/ggi.13712. Epub 2019 Jun 14. PMID: 31199563
• 3. Yang W, Tao Z, Chen H, Li Q, Chu PG, Yen Y, Qiu W. Amyand's hernia in elderly patients: diagnostic, anesthetic, and perioperative considerations. J Invest Surg. 2009 Nov-Dec;22(6):426-9. doi: 10.3109/08941930903410809. PMID: 20001812.
• 4. Kulacoglu H, Polat A, Moran M, Gök R, Coşkun F. Elective inguinal hernia repair in the elderly. TurkishJournal of Geriatrics. 2000;3(2):64-8.
• 5. Kartal A, Çitgez B, Besler E, Yetkin SG, Uludağ M, Akgün İE, et al. İnkarsere inguinal hernilerde deneyimimiz. Ş EEAH Tıp Bülteni 2014; 48: 287. 2014;90.
• 6. Ischer D, Renoult C, Gold B, Mégevand JM. La hernie fémorale chez la personne âgée [Femoral hernia in geriatric patient]. Rev Med Suisse. 2018 Jan 31;14(592):279-282. French. PMID: 29384275.
• 7. Primatesta P, Goldacre MJ. Inguinal hernia repair: incidence of elective and emergency surgery, readmission and mortality. International journal of epidemiology. 1996;25(4):835-9.
• 8. Fang Z, Ren F, Zhou J, Tian J. Biologic mesh versus synthetic mesh in open inguinal hernia repair: system review and meta-analysis. ANZ J Surg. 2015 Dec;85(12):910-6. doi: 10.1111/ans.13234. Epub 2015 Jul 17. PMID: 26183816.
• 9. Işıl, R.G., Demir, U., Kaya, C., Bostancı, Ö., İdiz, U.O., Işıl, C.T., Demircioğlu, M.K. and Mihmanlı, M., 2017. Approach to inguinal hernia in high-risk geriatric patients: Should it be elective or emergent?. Turkish Journal of Trauma and Emergency Surgery, 23(2), pp.122-127.
• 10. Elhage SA, Shao JM, Deerenberg EB, Prasad T, Colavita PD, Kercher KW, Augenstein VA, Todd Heniford B. Laparoscopic Ventral Hernia Repair in the Geriatric Population : An Assessment of Long-Term Outcomes and Quality of Life. Am Surg. 2020 Aug;86(8):1015-1021. doi:
• 11. Isil, R.G., Yazici, P., Demir, U., Kaya, C., Bostanci, O., Idiz, U.O., Isil, C.T. and Mihmanli, M., Outcomes of geriatric patients who underwent incarcerated inguinal hernia repair. Şişli Etfal Tıp Bülteni, 50(2), pp.103-109.