IMPACT OF COVID-19 LOCKDOWN ON EMERGENCY ABDOMINAL WALL HERNIA SURGERIES: A RETROSPECTIVE COHORT STUDY

Öz

AIM: The aim of our study is to evaluate the impact of nationwide lockdowns imposed due to the COVID-19 pandemic on the incidence of incarcerated inguinal, femoral, and incisional hernias in Türkiye. METHODS: A retrospective analysis was conducted on patients who underwent emergency surgery for strangulated abdominal wall hernias between 01/04/2020 and 01/04/2023. Patients were divided into two groups based on the timing of surgery. Surgeries performed during the COVID-19 pandemic restrictions were categorized as the lockdown period, while those outside of this date range were considered the free period. RESULTS: The study included a total of 135 cases, and the results revealed significant differences between the free and lockdown periods in terms of hernia types and postoperative outcomes. During the lockdown period, the emergency admission rate for incisional hernias increased from 27.2% to 43.8%, while the rate for inguinal hernias decreased from 42.5% to 22.9%. Intestinal resections increased from 6.9% in the free period to 18.8% in the lockdown period (p<0.05). The postoperative ICU admission rate increased from 12.6% to 27.1% (p<0.05). CONCLUSION: Our study found a proportional increase in incisional hernias during the closure period in hernia patients requiring emergency surgery, while a decrease in inguinal hernias was observed. An increase in the need for intensive care unit admissions was observed during this period and a significant increase in intestinal resections was observed. It emphasizes the need for ongoing research in this field to improve patient outcomes and inform clinical decision-making.

Anahtar Kelimeler

• COVID-19
• Hernia
• Incarceration
• Strangulation

Etik Beyan

Our study was conducted with the ethical approval numbered B.10.1.TKH.4.34.H.GP.0.01/179, obtained from the Clinical Research Ethics Committee of Ümraniye Training and Research Hospital, University of Health Sciences, on May 15, 2023

COVID-19 KISITLAMALARININ ACİL KARIN DUVARI FITIĞI AMELİYATLARINA ETKİSİ: RETROSPEKTİF KOHORT ÇALIŞMA

Öz

AMAÇ: Çalışmamızın amacı, COVID-19 pandemisi nedeniyle uygulanan ülke çapındaki kapanmaların Türkiye'de strangüle inguinal, femoral ve insizyonel fıtıkların insidansı üzerindeki etkisini değerlendirmektir. YÖNTEMLER: 01/04/2020 ile 01/04/2023 tarihleri arasında strangüle karın duvarı fıtığı nedeniyle acil cerrahi uygulanan hastalar üzerinde retrospektif bir analiz gerçekleştirildi. Hastalar ameliyat zamanlamasına göre iki gruba ayrıldı. COVID-19 pandemisi kısıtlamaları sırasında yapılan ameliyatlar “kapanma dönemi” olarak sınıflandırılırken, bu tarih aralığı dışında kalan ameliyatlar “serbest dönem” olarak kabul edildi. BULGULAR: Çalışmaya toplam 135 vaka dahil edildi ve serbest dönem ile kapanma dönemi arasında fıtık türleri ve postoperatif sonuçlar açısından anlamlı farklar olduğu ortaya kondu. Kapanma döneminde insizyonel fıtıklar için acil başvuru oranı %27,2’den %43,8’e yükselirken, inguinal fıtık oranı %42,5’ten %22,9’a düştü. Bağırsak rezeksiyonları serbest dönemde %6,9 iken kapanma döneminde %18,8’e yükseldi (p<0,05). Postoperatif yoğun bakım ünitesi (YBÜ) yatış oranı %12,6’dan %27,1’e yükseldi (p<0,05). SONUÇ: Çalışmamız, acil cerrahi gerektiren fıtık hastalarında kapanma döneminde insizyonel fıtıkların oransal olarak arttığını, inguinal fıtıkların ise azaldığını ortaya koymuştur. Bu dönemde yoğun bakım ihtiyacında bir artış ve bağırsak rezeksiyonlarında anlamlı bir artış gözlemlenmiştir. Bu bulgular, hasta sonuçlarını iyileştirmek ve klinik karar verme süreçlerine katkı sağlamak amacıyla bu alanda yapılacak araştırmaların devam etmesi gerektiğini vurgulamaktadır.

Anahtar Kelimeler

• COVID-19
• Fıtık
• İnkarserasyon
• Strangülasyon

Kaynakça

1. COVIDSurg Collaborative. Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans. Br J Surg 2020;107(11):1440-9.
2. van den Heuvel B, Dwars BJ, Klassen DR, Bonjer HJ. Is surgical repair of an asymptomatic groin hernia appropriate? A review. Hernia 2011;15(3):251-9.
3. Reistrup H, Zetner DB, Andersen K, Rosenberg J. [Article in Danish]. Ugeskr Laeger 2018;180(22):V09170710.
4. Feier CVI, Muntean C, Bardan R, Olariu A, Olariu S. Impact of Covid-19 pandemic on a general surgery clinic. J Med Life 2022;15(3):415-9.
5. Cuschieri S. The STROBE guidelines. Saudi J Anaesth 2019;13(Suppl 1):S31-4.
6. Topcu O, Kurt A, Soylu S, ve ark. Polypropylene mesh repair of incarcerated and strangulated hernias: a prospective clinical study. Surg Today 2013;43(10):1140-4.
7. Fitzgibbons RJ Jr, Giobbie-Hurder A, Gibbs JO, ve ark. Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial. JAMA 2006;295(3):285-92.
8. Howard R, Thumma J, Ehlers A, ve ark. Reoperation for recurrence up to 10 years after hernia repair. JAMA 2022;327(9):872-4.

9. Christoffersen MW. Clinical outcomes after elective repair for small umbilical and epigastric hernias. Dan Med J 2015;62(11):B5161.
10. Neumayer L, Giobbie-Hurder A, Jonasson O, ve ark. Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med 2004;350(18):1819-27.
11. Kokotovic D, Sjølander H, Gögenur I, Helgstrand F. Watchful waiting as a treatment strategy for patients with a ventral hernia appears to be safe. Hernia 2016;20(2):281-7.
12. Ewing AS, McFadyen R, Hodge K, ve ark. The impact of the COVID-19 pandemic on hernia surgery: the South-East Scotland experience. Cureus 2022;14(9):e29532.
13. Turan U, Dirim AB. The effects of COVID-19 pandemic on emergency anterior abdominal wall hernia surgery: is it safe to postpone elective hernia surgery in the pandemic? Eur J Trauma Emerg Surg 2022;48(2):833-9.
14. Kurt N, Oncel M, Ozkan Z, Bingul S. Risk and outcome of bowel resection in patients with incarcerated groin hernias: retrospective study. World J Surg 2003;27(6):741-3.
15. Surek A, Ferahman S, Gemici E, ve ark. Effects of COVID-19 pandemic on general surgical emergencies: are some emergencies really urgent? Level 1 trauma center experience. Eur J Trauma Emerg Surg 2021;47(3):647-52.
16. COVIDSurg Collaborative. Global guidance for surgical care during the COVID-19 pandemic. Br J Surg 2020;107(9):1097-103.