Acil inguinal hernilerde cerrahi yaklaşıma etki eden faktörler: tek merkez deneyimi

Abstract

Amaç: Kasık fıtığı nedeniyle acil girişim gereken hastalarda risk faktörlerini, tanı yöntemlerini, operasyon zamanını ve tekniklerini inceleyerek cerrahi prensipleri belirlemek. Gereç ve yöntem: 2017 ile 2022 yılları arasında kasık fıtığı onarımı ameliyatı geçiren hastalar retrospektif olarak incelendi. Çalışmada; demografik özellikler, fizik muayene bulguları, eşlik eden hastalıklar, radyolojik değerlendirmeler, operasyon notları, hastaneye varış zamanı ve operasyon süresi gibi çeşitli parametreler değerlendirildi. Veriler hastanenin elektronik tıbbi kayıt sisteminden toplandı. Hastalar, ameliyat öncesi değerlendirme şekline göre iki gruba ayrıldı: grup 1, ameliyat kararı sadece fizik muayene bulgularına dayanan hastaları içerirken; grup 2, ameliyattan önce radyolojik değerlendirmeye tabi tutulan hastaları içermekteydi. Bulgular: Kadın cinsiyet (%25) ve femoral fıtığa (%16,6) sahip hastalarda inkarserasyon ve buna bağlı acil cerrahi gereksinimi daha yüksek oranda izlenmiştir. Hastaların tanısı genellikle fizik muayene bulgularına dayanıyordu ancak radyolojik yöntemler de vakaların %75'inde ameliyat öncesi değerlendirmede kullanıldı. Radyolojik değerlendirmelerin operasyon süresini artırdığı ve daha yüksek morbidite ve bağırsak rezeksiyonu oranlarına neden olduğu gözlemlendi. Sonuç: Obezite ve nüks fıtık gibi şüpheli durumlar dışında, acil fıtık cerrahisi geçiren hastalarda radyolojik yöntemler, tedaviyi geciktirebilir ve morbidite ve mortalite oranlarını artırabilir. İnkarserasyon veya strangülasyon durumlarında fizik muayene bulgularına dayalı hızlı cerrahi müdahale hayati önem taşır. Spontan redüksiyon durumlarında bağırsak canlılığına dair herhangi bir şüphe varsa eksplorasyon, hernioskopi, laparoskopi veya laparotomi düşünülmelidir.

Keywords

• İnguinal
• herni
• acil
• cerrahi

A single-center study on the factors affecting the surgical approach in emergent inguinal hernias

Abstract

Purpose: The aim is to establish the principles of surgery for patients who have undergone emergency groin hernia surgery by examining risk factors, diagnostic modalities, time to operation, and surgical techniques. Materials and methods: A retrospective analysis was conducted on patients who underwent groin hernia repair surgery between the years 2017 and 2022. The study evaluated various parameters such as demographic characteristics, physical examination findings, co-morbidities, radiologic assessments, operation notes, time of arrival to the hospital, and the duration of the operation. Data was collected from the hospital's electronic medical records system. Based on the mode of pre-operative assessment, patients were classified into two groups: group 1, comprising patients whose decision for surgery was based on physical examination alone, and group 2, comprising patients who underwent radiologic assessment prior to the operation. Result: The risk evaluation of patients who underwent emergent hernia surgery revealed a higher incidence of women gender (25%) and femoral hernia type (16.6%) as compared to the elective surgery group, where the incidence was 6.7% and 1.6%, respectively. The diagnosis of patients was primarily based on physical examination findings, although radiologic methods were used preoperatively in 75% of the cases. It was observed that radiologic assessments increased the duration of the operation and resulted in higher morbidity and intestinal resection rates. Conclusion: Radiologic methods, apart from in cases of suspected conditions such as obesity and recurrent hernias, may lead to delayed treatment and increased morbidity and mortality rates in patients undergoing emergent hernia surgery. Prompt surgical intervention based on physical examination findings is crucial in cases of strangulation or incarceration. In instances of spontaneous reduction, incisional exploration, hernioscopy, laparoscopy, or laparotomy should be considered if there is any suspicion of intestinal viability.

Keywords

• Inguinal
• hernia
• emergency
• surgery

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