İnguinal herninin günübirlik cerrahisi: Cerrahi asistanları tarafından lokal anestezi altında gerçekleştirilen Lichtenstein inguinal herni onarımı

Yıl 2016, , 4 - 7, 30.12.2016

İsmail Ege Subaşı Metin Yucel , Mustafa Hasbahçeci , Fatih Başak , Orhan Alimoglu

https://doi.org/10.25000/acem.289465

Öz

Amaç: Lokal anestezi ile günü birlik cerrahi olarak uygulanan Lichtenstein inguinal herni onarımı, cerrahi eğitim programı kapsamın yapılan eğitimlerin başında gelmektedir. Bu çalışmada, asisten hekimlerin yaptığı bu ameliyatı incelemeyi amaçladık.

Gereç ve Yöntemler: Primer inguinal herni tanısı alan 40 yaş ve üstü erkek hastalar, Haziran 2009-Mart 2011 arasında ileriye dönük olarak çalışmaya dahil edildi. Tekrarlama ve kronik postoperatif ağrı açısından cerrahi sonuçlar çalışıldı.

Bulgular: Yaş ortalaması 55,7±10,8 olan 151 hasta vardı. İntraoperatif değerlendirme 84 (%55,6) direk fıtık, 58 (%38,4) indirekt ve dokuz (%6,0) direk-indirekt fıtık birlikteliği vardı. Ortalama operasyon süresi 51,2 ±13,2 dakikaydı ve bu obez hastalarda anlamlı derecede yüksekti (p<0,05). Postoperatif dönemde 143 (%94,7) hasta, ilk sekiz saat içinde taburcu edildi. Hastaların çoğu (%90,7) lokal anesteziyi tekrar seçeceğini ifade etti. Onbir hastanın ağrı skoru 6. ve 12. ay değerlendirmelerinde 0,23±0,7 (dağılım 0-4) ve 0,07±0,4 (dağılım 0-3) olarak tespit edildi. Postoperatif 1. günde, 137 (%90,7) hasta günlük aktivitelerine geri döndü. 28 (%18,5) hematom ve seroma oluşumu ve 18 (%11,9) yara enfeksiyonu vardı. Mesh reaksiyonu saptanmadı; Ancak bir yıl operasyondan sonra iki (%1.3) rekürrens tespit edildi.

Sonuç: Lichtenstein inguinal herni onarımı, lokal anestezi altında günlük cerrahi girişim olarak birincil tedavi yöntemi olarak seçilmeli ve ameliyat asistanlar tarafından gözetim altında güvenli bir şekilde yapılabilir.

Anahtar kelimeler: İnguinal herni onarımı, Lokal anestezi, Günübirlik cerrahi

Anahtar Kelimeler

Fıtık onarımı, Lokal anestezi, Günü birlik cerrahi

Day-case surgery for inguinal hernia: Lichtenstein inguinal hernia repair under local anesthesia performed by surgical residents.

Öz

Background: Lichtenstein inguinal hernia repair
with local anesthesia as a day-case surgery is one of aspects of education in
inguinal hernia surgery as a surgical training program. In this study, we aimed
to present these surgery performed by residents.

Methods: Forty years and older male patients
diagnosed as primary inguinal hernia were included prospectively between June
2009 and March 2011. Surgical outcomes with respect to recurrence and chronic
postoperative pain were studied.

Results: There were 151 patients with a mean
age of 55.7±10.8. Intraoperative evaluation revealed direct in 84 (55.6%),
indirect in 58 (38.4%) and combined hernia in 9 (6.0%). Mean operation time was
51.2±13.2 minutes which was significantly higher in obese patients (p<0.05).
Patients were discharged at postoperatively 8 hours or less in 143 (94.7%).
Most of the patients (90.7%) were reported to choose local anesthesia again.
Eleven and four patients reported pain scores of 0.23±0.7 (range 0-4) and
0.07±0.4 (range 0-3) at 6th and 12th month evaluations, respectively. At the
postoperative 1st day, 137 (90.7%) patients could return to daily activities.
There were 28 (18.5%) hematoma and seroma formation, and 18 (11.9%) wound
infection. There was no mesh reaction; however, 2 (1.3%) recurrences were
detected after one year of the operation.

Conclusions: Lichtenstein inguinal hernia
repair under local anesthesia as a day case surgery should be chosen as a
primary treatment method, and can be performed by surgical residents under
supervision in a safe manner.   

Anahtar Kelimeler

Hernia repair, Local anesthesia, Day-case surgery

Kaynakça

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