Böbrek Nakli Alıcılarında İnsizyonel Herni: Tek Merkez Deneyimi

Öz

Amaç: İnsizyonel herni, hastaların yaşam kalitesini olumsuz etkileyebilecek ciddi bir komplikasyon olup tüm ameliyatlardan sonra görülebilir. İnsidansı, böbrek naklinden sonra % 1 ile 5 arasındadır. Bu retrospektif çalışmanın amacı, böbrek nakli sonrası alıcı hastalarda gelişen insizyonel hernilerin değerlendirilmesidir. Gereç ve Yöntem: Nisan 2014 - Nisan 2019 tarihleri arasında ..... Üniversitesi Tıp Fakültesi Hastanesi Organ Nakli Bölümü'nde, böbrek nakli yapılan 150 hasta retrospektif olarak incelendi. İnsizyonel herni 7 (% 4.7) hastada saptandı. Bu hastaların demografik ve klinik özellikleri, predispozan faktörleri ve cerrahi sonuçları değerlendirildi. Bulgular: Böbrek nakli sonrası insizyonel herni saptanan hastaların yaş ortalaması 61±3.2 yıldı. Bu hastaların 5’i (%71.4) erkekti. Hastaların ortalama Vücut Kitle İndeksi (VKİ) 34.8±2.1 kilogram/ metrekare (kg / m2) idi. Hastalardan 5’inde (%71.4) Diabetus Mellitus vardı. Hastalardan 5’inde (%71.4) yara yeri enfeksiyonu mevcuttu. Tüm hastalar prolene mesh greft ile onarıldı (açık-onlay tekniği ile). Otuz dokuz (14-60) aylık takipte komplikasyon ve nüks görülmedi. Sonuç: Risk grubunda yaşlı, obez, diyabetik ve ameliyat sonrası yara yeri infeksiyonu gelişen hastalar vardı. Böbrek nakli sonrası gelişen insizyonel hernilerin erken tanı ve tedavisi için özellikle bu hasta gruplarına dikkat edilmesi gerektiğini düşünüyoruz.

Anahtar Kelimeler

• İnsizyonel herni,Böbrek nakli,Analiz

Incisional Hernia in Kidney Transplant Recipients: A Single Center Experience

Öz

Aim: An incisional hernia is a serious complication that can negatively affect patients quality of life and can be seen after all operations. Its incidence is between 1 and 5% after kidney transplantation. The aim of this retrospective study has been to evaluate the incisional hernias developing in recipient patients after kidney transplantation. Materials and Methods: Between April 2014 and April 2019, 150 patients who underwent kidney transplantation at ..... University Medical Faculty Organ Transplant Department were retrospectively analyzed. The incisional hernia was detected in 7 (4.7%) patients. Demographic and clinical features, predisposing factors and surgical results of these patients were evaluated. Results: The mean age of patients with an incisional hernia after kidney transplantation was 61 ± 3.2 years. Five of these patients (71.4%) were male. The mean Body Mass Index (BMI) of the patients was 34.8 ± 2.1 kilograms / square meter (kg / m2). Diabetes Mellitus was present in 5 patients (71.4%). Wound infection was present in 5 (71.4%). All patients were repaired with a prolene mesh graft (open onlay technique). No complication and recurrence was observed in the thirty-nine (14-60) months follow-up. Conclusions: There were elderly, obese, diabetic and postoperative wound infection patients in the risk group. We think, attention must be paid especially in these patient groups for the early diagnosis and treatment of incisional hernias develop after liver transplantation.

Anahtar Kelimeler

• Incisional hernia,Kidney transplantation,Analysis

Kaynakça

1. 1.Hidalgo MP, Ferrero EH, Ortiz MA. et al. Incisional hernia in patients at risk: can it be prevented? Hernia 2011; 15 : 371-375.
2. 2. Smith CT, Katz MG, Foley D. et al. Incidence and risk factors of incisional hernia formation following abdominal organ transplantation. Surg Endosc 2015; 29: 398-404.
3. 3.Yahchouchy-Chouillard E, Aura T, Picone O. et al. Incisional hernias. I. Related risk factors. Dig Surg, 2003; 20: 3-9.
4. 4. Forbes SS, Eskicioglu C, McLeod RS. et al. Meta-analysis of randomized controlled trials comparing open and laparoscopic ventral and incisional hernia repair with mesh. Br J Surg 2009; 96: 851-858.
5. 5.Ooms LS, Verhelst J, Jeekel J. et al. Incidence, risk factors, and treatment of incisional hernia after kidney transplantation: an analysis of 1,564 consecutive patients. Surgery 2016; 159:1407-1411.
6. 6.Dean PG, Lund WJ, Larson TS. et al. Wound-healing complications after kidney transplantation: a prospective, randomized comparison of sirolimus and tacrolimus. Transplantation 2004; 77: 1555-1561.
7. 7. Durinka JB, Parsikia A, Karipineni F. et al. Association between delayed graft function and incisional hernia after renal transplant. Exp Clin Transplant 2017; 15: 27-33.
8. 8.Valente JF, Hricik D, Weigel K. et al. Comparison of sirolimus vs. mycophenolate mofetil on surgical complications and wound healing in adult kidney transplantation. Am J Transpl 2003; 3: 1128-1134.

9. 9. Moris D, Bokos J, Vailas M. et al. Renal paratransplant hernia revealed: a review of the literatüre. Hernia 2017; 21: 363-367.
10. 10. Petro CC, Orenstein SB, Criss CN. et al. Transversus abdominis muscle re¬lease for repair of complex incisional hernias in kidney transplant recipi¬ents. Am J Surg 2015; 210: 334-39.
11. 11. Kieszek R, Wszola M, Domagała P. et al. Current trends in the treatment of incisional hernia in patients after kidney transplantation. Pol Merkur Lekarski 2010; 29: 50-53.
12. 12.Mahdavi R, Mehrabi M. Incisional hernia after renal transplantation and its repair with propylene mesh. Urol J 2004; 1: 259-262.
13. 13.Chang EI, Galvez MG, Padilla BE. et al. Ten-year retrospective analysis of incisional herniorrhaphy following renal transplantation. Arch Surg Chic Ill 1960, 2011; 146: 21-25.
14. 14.Li EN, Silverman RP, Goldberg NH. Incisional hernia repair in renal transplantation patients. Hernia: the journal of hernias and abdominal wall surgery 2005; 9: 231-237.
15. 15. Varga M, Matia I, Kucera M. et al. Polypropylene mesh repair of incisional hernia after kidney transplantation: single-center experience and review of the literature. Annals of transplantation 2011;16: 121-125.