Delta nötrofil indeksi, inkarsere inguinal fıtıklarda barsak rezeksiyonu gereğini öngörmede bir belirteç olarak kullanılabilir mi?

Öz

Amaç: Delta nötrofil indeksi, immatür granülositlerin nötrofil sayısına oranını gösteren bir parametredir. Bu çalışma, DNI'nin inkarsere inguinal herni hastalarında strangülasyon varlığını öngörmedeki gücünü belirlemeyi amaçlamaktadır. Yöntem: Mayıs 2021-Mayıs 2022 tarihleri arasında inkarsere kasık fıtığı nedeniyle kliniğimize başvuran ve opere edilen hastaların dosyaları geriye dönük olarak incelendi. Hastaların dosyalarından yaş, cinsiyet, fıtık tipi, lökosit, lenfosit, nötrofil, trombosit, monosit değerleri, delta nötrofil indeksi, uygulanan cerrahi yöntem ve barsak rezeksiyonu yapılıp yapılmadığı öğrenildi. Hastalar barsak iskemisi nedeniyle barsak rezeksiyonu yapılanlar (grup 1) ve yapılmayanlar (grup 2) olarak iki gruba ayrıldı. Bulgular: Seksen bir hasta çalışmaya dahil edildi. 70 (%86,4) hastaya barsak rezeksiyonu yapılmadığı, 11 (%13,6) hastaya barsak rezeksiyonu yapıldığı belirlendi. Grup 1'deki hastaların ortanca DNI değeri 0,30 (0,10 - 1,20), Grup 2'deki hastaların ortanca DNI değeri 0,30 (0,10 - 1,30) idi ve aradaki fark istatistiksel olarak anlamlı değildi (p=0,77). Sonuç: İnkarsere inguinal hernisi olan hastalarda inkarsere barsak segmentinde iskemi varlığını öngörmek için delta nötrofil indeksi güçlü bir prediktif değer olmayabilir.

Anahtar Kelimeler

• Delta nötrofil indeks
• İnkarsere inguinal herni
• strangülasyon

May the delta neutrophil index be used as a marker to predict the need for bowel resection in incarcerated hernias?

Öz

Objective: Delta neutrophil index is a parameter that shows the ratio of immature granulocytes to the neutrophil count. This study aims to determine the power of DNI in predicting the presence of strangulation in incarcerated inguinal hernias. Methods: The files of the patients who were admitted to our clinic and operated due to incarcerated inguinal hernia between May 2021 and May 2022 were reviewed retrospectively. The patients' age, gender, hernia type, leukocyte, lymphocyte, neutrophil, platelet, monocyte values, delta neuthrophil index, the surgical method applied, and whether bowel resection was performed were extracted from the patient files. The patients were divided into two groups patients who underwent bowel resection because of bowel ischemia (group 1) and those who did not (group 2). Results: Eighty-one patients were included in the study. It was determined that 70 (86.4%) patients did not undergo bowel resection, and 11 (13.6%) underwent bowel resection. The median DNI value of the patients in Group 1 was 0.30 (0.10 - 1.20), and the median DNI value of the patients in Group 2 was 0.30 (0.10 - 1.30), and the difference was not statistically significant (p=0.77) Conclusion: Delta neutrophil index may not be an accurate predictive value to predict the presence of ischemia in the incarcerated bowel segment in patients with incarcerated inguinal hernia.

Anahtar Kelimeler

• Delta neutrophil index
• Incarcerated inguinal hernia
• strangulation

Kaynakça

1. 1. Kingsnorth A, LeBlanc K. Hernias: Inguinal and incisional. Lancet. 2003;8:1561-1571.
2. 2. Simons MP, Smietanski M, Bonjer HJ, Bittner R, Miserez M, Aufenacker TJ, et al. International guidelines for groin hernia management. Hernia. 2018;22(1):1-165.
3. 3. Ceresoli M, Carissimi F, Nigro A, Fransvea P, Lepre L, Braga M, et al. Emergency hernia repair in the elderly: multivariate analysis of morbidity and mortality from an Italian registry. Hernia. 2022;26: 165–175.
4. 4. Kulah B, Duzgun AP, Moran M, Kulacoglu IH, Ozmen MM, Coskun F. Emergency hernia repairs in elderly patients. Am J Surg. 2001;182: 455–459.
5. 5. Chen P, Yang W, Zhang J, Wang C, Yu Y, Wang Y, et al. Analysis of risk factors associated bowel resection in patients with incarcerated groin hernia. Medicine. 2020;99: e20629.
6. 6. Alhambra-Rodriguez de Guzmán C, Picazo-Yeste J, Tenías-Burillo JM, Moreno-Sanz C. Improved outcomes of incarcerated femoral hernia: a multivariate analysis of predictive factors of bowel ischemia and potential impact on postoperative complications. Am J Surg. 2013;205: 188–193.
7. 7. Pawlak M, East B, de Beaux AC. Algorithm for management of an incarcerated inguinal hernia in the emergency settings with manual reduction. Taxis, the technique and its safety. Hernia. 2021;25: 1253–1258.
8. 8. Nilsson E, Kald A, Anderberg B, Bragmark M, Fordell R, Haapaniemi S, et al. Hernia surgery in a defined population: a prospective three year audit. Eur J Surg. 1997;163: 823–829.

9. 9. Primatesta P, Goldacre MJ. Inguinal Hernia Repair: Incidence of Elective and Emergency Surgery, Readmission and Mortality. International Journal of Epidemiology. 1996;25:835-839.
10. 10. LeBlanc KA, Kingsnorth A, Sanders DL, editors. Management of Abdominal Hernias. Springer, Cham; 2018.
11. 11. Pastorino A, Alshuqayfi AA. Strangulated Hernia. StatPearls. Treasure Island (FL): StatPearls Publishing; 2021.
12. 12. Kroese LF, Sneiders D, Kleinrensink GJ, Muysoms F, Lange JF. Comparing different modalities for the diagnosis of incisional hernia: a systematic review. Hernia. 2018;22: 229–242.
13. 13. Miller J, Cho J, Michael MJ, Saouaf R, Towfigh S. Role of imaging in the diagnosis of occult hernias. JAMA Surg. 2014;149: 1077–1080.
14. 14. Van den Berg JC, de Valois JC, Go PM, Rosenbusch G. Detection of groin hernia with physical examination, ultrasound, and MRI compared with laparoscopic findings. Invest Radiol. 1999;34: 739–743.
15. 15. Icoz G, Makay O, Sozbilen M, Gurcu B, Caliskan C, Firat O, et al. Is D-dimer a predictor of strangulated intestinal hernia? World J Surg. 2006;30: 2165–2169.
16. 16. Koizumi M, Sata N, Kaneda Y, Endo K, Sasanuma H, Sakuma Y, et al. Optimal timeline for emergency surgery in patients with strangulated groin hernias. Hernia. 2014;18: 845–848.
17. 17. Kratz A, Maloum K, O’Malley C, Zini G, Rocco V, Zelmanovic D, et al. Enumeration of nucleated red blood cells with the ADVIA 2120 Hematology System: an International Multicenter Clinical Trial. Lab Hematol. 2006;12: 63–70.
18. 18. Bermejo-Martín JF, Tamayo E, Ruiz G, Andaluz-Ojeda D, Herrán-Monge R, Muriel-Bombín A, et al. Circulating neutrophil counts and mortality in septic shock. Critical Care. 2014;18(1):407.
19. 19. Jeong HM, Bang CS, Lee JJ, Baik GH. Delta Neutrophil Index for the Prediction of Prognosis in Acute Gastrointestinal Diseases; Diagnostic Test Accuracy Meta-Analysis. J Clin Med Res. 2020;9(4):1133.
20. 20. Park JH, Byeon HJ, Lee KH, Lee JW, Kronbichler A, Eisenhut M, et al. Delta neutrophil index (DNI) as a novel diagnostic and prognostic marker of infection: a systematic review and meta-analysis. Inflamm Res. 2017;66: 863–870.
21. 21. Akin ML, Karakaya M, Batkin A, Nogay A. Prevalence of inguinal hernia in otherwise healthy males of 20 to 22 years of age. J R Army Med Corps. 1997;143: 101–102.
22. 22. Rosemar A, Angerås U, Rosengren A, Nordin P. Effect of body mass index on groin hernia surgery. Ann Surg. 2010;252: 397–401.
23. 23. Liem MS, van der Graaf Y, Beemer FA, van Vroonhoven TJ. Increased risk for inguinal hernia in patients with Ehlers-Danlos syndrome. Surgery. 1997;122: 114–115.
24. 24. 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: 741–743.
25. 25. Burcharth J, Pedersen M, Bisgaard T, Pedersen C, Rosenberg J. Nationwide prevalence of groin hernia repair. PLoS One. 2013;8:54367.
26. 26. Dwertmann AK, Soppe S, Hefermehl L, Keerl A, Wirsching A, Nocito A. Risk of bowel resection in incarcerated inguinal hernia: watch out for ASA score and hernia type. Langenbecks Arch Surg. 2022;17:423.
27. 27. Chen P, Huang L, Yang W, He D, Liu X, Wang Y, et al. Risk factors for bowel resection among patients with incarcerated groin hernias: A meta-analysis. Am J Emerg Med. 2020;38: 376–383.
28. 28. Zhou H, Ruan X, Shao X, Huang X, Fang G, Zheng X. Clinical value of the neutrophil/lymphocyte ratio in diagnosing adult strangulated inguinal hernia. Int J Surg. 2016;36: 76–80.
29. 29. Xie X, Feng S, Tang Z, Chen L, Huang Y, Yang X. Neutrophil-to-Lymphocyte Ratio Predicts the Severity of Incarcerated Groin Hernia. Med Sci Monit. 2017;23: 5558–5563.
30. 30. Nilsson H, Nilsson E, Angerås U, Nordin P. Mortality after groin hernia surgery: delay of treatment and cause of death. Hernia. 2011;15: 301–307.
31. 31. Gönüllü E, Kucuk F, Bayhan Z, Harmantepe AT, Capoglu R. Akut Kolesistitte Kolesistektomi veya Kolesistostomi Yapılması Gerekecek Hastaların Ayırt Edilmesinde Biyolojik İndeksler Kullanılabilir mi? Sak Med J. 2022;3:489-495.