Tek seansta ventral herni onarımı ile birlikte pannikülektomi de uygulanmalı mı?

Year 2021, Volume: 46 Issue: 3, 959 - 965, 30.09.2021

Serdar Kırmızı , Emil Hüseyinoğlu

https://doi.org/10.17826/cumj.902212

Abstract

Amaç: Bu çalışmanın amacı, ventral hernide eş zamanlı pannikülektomi uygulamasının postoperatif morbidite oranlarını artırıp artırmadığını araştırmaktır.
Gereç ve Yöntem: Çalışma Ocak 2018- Aralık 2020 tarihleri arasında Yozgat Şehir Hastanesi Genel Cerrahi Servisinde, retrospektif olarak gerçekleştirildi. Hastaların cinsiyet, yaş, vücut kitle indeksi, yandaş hastalıkları, herni tipi ve boyutu, geçirilmiş karın cerrahisi öyküsü, ASA değeri (American Society of Anesthesiology), post-operatif komplikasyonlar, hastane yatış ve takip süreleri değerlendirildi. Post-operatif komplikasyonlar Clavien-Dindo sınıflamasına göre değerlendirildi.
Bulgular: On dört hastaya eş zamanlı pannikülektomi ve ventral herni onarımı (Grup 1), 27 hastaya sadece ventral herni onarımı (Grup 2) yapıldı. Grup 1’de herni defekti alanı yaklaşık 6,25 kat daha fazlaydı. Hastane yatış süresi pannikülektomi uygulanan hastalarda anlamlı olarak daha uzundu. Ortanca takip süresi Grup 1 hastalarda 8,5 ay (2-14), diğer grupta 14 aydı (3-36). Çoklu lineer regresyon analizlerinde hastane yatış süresi üzerinde sadece herni defekt alanın anlamlı etkisi olduğu görüldü. En ciddi komplikasyon Clavien-Dindo sınıflamasına göre 3b (genel anestezi altında cerrahi müdahale) grubunda oluşan cilt nekrozuydu. Yara yeri komplikasyon ve herni rekürrensi açısından gruplar arasında anlamlı fark saptanmadı.
Sonuç: Ventral herni onarımların eş zamanlı pannikülektomi uygulaması komplikasyonları ve nüks oranını artırmamaktadır. Her iki probleminden de tek seansta kurtulmak isteyen hastalara güvenle uygulanabilir.

Keywords

Ventral herni, insizyonel herni, umblikal herni, epigastrik herni, pannikülektomi

Should panniculectomy be applied with ventral hernia repair in a single session?

Abstract

simultaneous panniculectomy applications in ventral hernia repair increases postoperative morbidity rates.
Materials and Methods: The study was carried out retrospectively between January 2018 and December 2020. The patients were evaluated in terms of sex, age, body mass index, accompanying diseases, hernia type and size, abdominal surgery history, ASA value (American Society of Anesthesiology), postoperative complications, hospitalization, and follow-up durations. Post-operative complications were evaluated according to the Clavien-Dindo classification.
Results: It was determined that 14 patients underwent simultaneous panniculectomy and ventral hernia repair (Group 1), while 27 patients underwent sole ventral hernia repair (Group 2). In Group 1, the hernia defect area was approximately 6.25-fold higher. In patients with a panniculectomy, hospitalization time was significantly longer. The median follow-up period was 8.5 months (2-14) in Group 1, and 14 months in Group 2 (3-36). In multiple linear regression analyses, only the effect hernia defect area was significant on the hospitalization time. There were no significant differences between the groups in terms of complications and hernia recurrence.
Conclusion: Simultaneous panniculectomy applications in ventral hernia repairs do not increase the rate of complications and hernia recurence. A simultaneous panniculectomy application can be applied safely to patients who want to “eliminate” both of their problems in a single session.

Keywords

Ventral hernia, incisional hernia, umbilical hernia, epigastric hernia, panniculectomy

References

• Schlosser KA, Arnold MR, Otero J, Prasad T, Lincourt A, Colavita PD, et al. Deciding on optimal approach for ventral hernia repair: laparoscopic or open. Journal of the American College of Surgeons. 2019;228(1):54-65.
• Olavarria OA, Bernardi K, Shah SK, Wilson TD, Wei S, Pedroza C, et al. Robotic versus laparoscopic ventral hernia repair: multicentre, blinded randomized controlled trial. BMJ (Clinical research ed). 2020;370:m2457.
• Ozkan H, Acar A, Gökce AH. Shall we use a mesh in every patient undergoing repair surgery for umbilical hernia? a prospective study. Cukurova Medical Journal 2019;44(1):169-75.
• Cooper JM, Paige KT, Beshlian KM, Downey DL, Thirlby RC. Abdominal panniculectomies: high patient satisfaction despite significant complication rates. Annals of plastic surgery. 2008;61(2):188-96.
• Zemlyak AY, Colavita PD, El Djouzi S, Walters AL, Hammond L, Hammond B, et al. Comparative study of wound complications: isolated panniculectomy versus panniculectomy combined with ventral hernia repair. journal of surgical research. 2012;177(2):387-91.
• Fischer JP, Basta MN, Wink JD, Wes AM, Kovach SJ. Optimizing patient selection in ventral hernia repair with concurrent panniculectomy: an analysis of 1974 patients from the ACS-NSQIP datasets. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2014;67(11):1532-40.
• Saxe A, Schwartz S, Gallardo L, Yassa E, Alghanem A. Simultaneous panniculectomy and ventral hernia repair following weight reduction after gastric bypass surgery: is it safe? Obesity surgery. 2008;18(2):192-5.
• Warren JA, Epps M, Debrux C, Fowler III JL, Ewing JA, Cobb WS, et al. Surgical site occurrences of simultaneous panniculectomy and incisional hernia repair. The American Surgeon. 2015;81(8):764-9.
• Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E, et al. Classification of primary and incisional abdominal wall hernias. Hernia : the journal of hernias and abdominal wall surgery. 2009;13(4):407-14.
• Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Annals of surgery. 2004;240(2):205-13.
• Gurunluoglu R, Williams SA, Johnson JL. A classification system in the massive weight loss patient based on skin lesions and activity of daily living. Eplasty. 2012;12:e12.
• Kokotovic D, Burcharth J, Helgstrand F, Gögenur I. Systemic inflammatory response after hernia repair: a systematic review. Langenbeck's archives of surgery. 2017;402(7):1023-37.
• Jess P, Schultz K, Bendtzen K, Nielsen OH. Systemic inflammatory responses during laparoscopic and open inguinal hernia repair: a randomised prospective study. The European journal of surgery = Acta chirurgica. 2000;166(7):540-4.
• McNichols CHL, Diaconu S, Liang Y, Ikheloa E, Kumar S, Kumar S, et al. Outcomes of Ventral Hernia Repair With Concomitant Panniculectomy. Annals of plastic surgery. 2018;80(4):391-4.
• Holihan JL, Nguyen DH, Nguyen MT, Mo J, Kao LS, Liang MK. Mesh Location in Open Ventral Hernia Repair: A Systematic Review and Network Meta-analysis. World journal of surgery. 2016;40(1):89-99.
• Cammarata MJ, Kantar RS, Rifkin WJ, Greenfield JA, Levine JP, Ceradini DJ. Advanced Age Is a Risk Factor for Complications Following Abdominal Panniculectomy. Obes Surg. 2019;29(2):426-33.
• Harth KC, Blatnik JA, Rosen MJ. Optimum repair for massive ventral hernias in the morbidly obese patient--is panniculectomy helpful? American journal of surgery. 2011;201(3):396-400.
• Maloney SR, Schlosser KA, Prasad T, Colavita PD, Kercher KW, Augenstein VA, et al. The impact of component separation technique versus no component separation technique on complications and quality of life in the repair of large ventral hernias. Surgical endoscopy. 2020;34(2):981-7.
• Giordano S, Garvey PB, Baumann DP, Liu J, Butler CE. Concomitant Panniculectomy Affects Wound Morbidity but Not Hernia Recurrence Rates in Abdominal Wall Reconstruction: A Propensity Score Analysis. Plastic and reconstructive surgery. 2017;140(6):1263-73.
• Simon S, Thaller SR, Nathan N. Abdominoplasty combined with additional surgery: a safety issue. Aesthetic surgery journal. 2006;26(4):413-6.
• Janis JE, Khansa I. Evidence-Based Abdominal Wall Reconstruction: The Maxi-Mini Approach. Plastic and reconstructive surgery. 2015;136(6):1312-23.
• Shubinets V, Fox JP, Tecce MG, Mirzabeigi MN, Lanni MA, Kelz RR, et al. Concurrent panniculectomy in the obese ventral hernia patient: assessment of short-term complications, hernia recurrence, and healthcare utilization. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2017;70(6):759-67.
• Hutchison CE, Rhemtulla IA, Mauch JT, Broach RB, Enriquez FA, Hernandez JA, et al. Cutting through the fat: a retrospective analysis of clinical outcomes, cost, and quality of life with the addition of panniculectomy to ventral hernia repair in overweight patients. Hernia : the journal of hernias and abdominal wall surgery. 2019;23(5):969-77.
• Elhage SA, Marturano MN, Deerenberg EB, Shao JM, Prasad T, Colavita PD, et al. Impact of panniculectomy in complex abdominal wall reconstruction: a propensity matched analysis in 624 patients. 2020:1-8. doi: 10.1007/s00464-020-08011-7 (in press)