Dağınık kırsal yerleşim bölgesinde boğulmuş fıtık ve geç başvuru sonuçları

Yıl 2012, Cilt: 22 Sayı: 3, 83 - 86, 01.01.2012

Candaş Erçetin Ahmet Cem Dural Mahir Kırnap Nazlı Ferhan Sayit Tugan Tezcaner

Öz

Amaç: Dağınık nüfus yerleşimli ilimizde, hastanemize başvuran boğulmuş fıtık olgularının başvuru yeri ve süresine göre değerlendirilmesi amaçlandı. Yöntem Mayıs 2009–2011 arasında boğulmuş fıtık tanısı ile ameliyat edilen olgular retrospektif olarak değerlendirildi. Bulgular: Elli iki olgunun yaş ortalaması 53,6 , erkek/kadın oranı 48/4 idi. Kırsal bölgeden başvuru % 52 idi n=27 . Gecikmiş başvuru oranı, kırsal bölge yerleşimli olgularda % 33,3 idi n=9 . Ameliyat öncesi değerlendirmede olguların % 50’si n=26 ASA II-III idi. En sık % 52 omental inkarserasyon n=27 görüldü. Olguların % 13,4’ünde rezeksiyon gerekli oldu. Olguların % 88,4’ünde Lichtenstein yöntemi ile herni tamiri uygulandı. Komplikasyon oranı % 15,3 n=8 iken, kırsal bölge başvurularında % 18,5 idi. Ortalama hastanede kalış süresi 3,8 gün idi. Bir yıllık takip sürecinde 3 olguda % 5,7 nüks görüldü. Sonuç: Kırsal bölgeden gecikmiş başvuru oranı yüksek olup anlamlı fark gözlenmedi. Elliiki olgunun değerlendirilmesinde; ilk 24 saat içinde girişim yapılan olgularda komplikasyon oranı ve hastanede kalış süresinin daha az olduğu görüldü

Anahtar Kelimeler

Kırsal yerleşim, boğulmuş fıtık, geç başvuru

The results of incarcerated hernias with delayed admission in a rural region with scattered settlement

Öz

Objective: The study was aimed to evaluate the outcomes of incarcerated hernias who were admitted to our emergency department in two years according to admission interval and place of residence. Methods: The records of patients undergoing emergency surgical operation for incarcerated hernias in our hospital between May 2009-2011 were analyzed retrospectively. Results: The mean age of 52 patients was 53.6 years, with a male/female ratio of 48/4. The admission rate from scattered rural settlement was 52% n=27 and delayed admission rate was 33.3% n=9 among these patients. Fifty percent of the patients n=26 were classified as ASA II or III. Omentum was most frequently incarcerated, in 27 52% hernias. Resection was needed in 13.4% of the patients. Lichtenstein hernia repair was performed in 88.4% of the patients. The complication rate was 15.3% n=8 and 18.5% for the patients admitted from a rural region. The length of hospitalization ranged from 1-34 days mean 3.8 . In our case series, there were 3 recurrences after one year follow-up. Conclusion: Although late hospitalization was more common among those who live in a rural region, no statistically significant difference was observed. We found a lower complication rate and shorter hospitalization when the patients were operated within first 24 hours of the incarceration

Anahtar Kelimeler

Scattered rural settlement, incarcerated hernia, delayed admission

Kaynakça

• Ohana G, Manevwitch I, Weil R, Melki Y, Seror D, Powsner E, et al. Inguinal hernia: challenging the traditional indication for surgery in asymptomatic patients. Hernia 2004; 8:117-20.
• Smietanski M, Lukasiewicz J, Bigda J, Lukianski M, Witkowski P, Sledzinski Z. Factors influencing surgeons’ choice of method for hernia repair technique. Hernia 2005;9:42-5.
• Kulah B, Kulacoglu IH, Oruc MT, Duzgun AP, Moran M, Ozmen MM, et al. Presentation and outcome of incarcerated external hernias in adults. Am J Surg 2001;181: 101-4.
• Derici H, Unalp HR, Bozdag AD, Nazli O, Tansug T, Kamer E. Factors affecting morbidity and mortality in incarcerated abdominal wall hernias. Hernia 2007;11:341-6.
• Akcakaya A, Alimoglu O, Hevenk T, Bas G, Sahin M. Mechanical intestinal obstruction caused by abdominal wall hernias. Ulus Travma Derg 2000;6:260-5.
• Forte A, D’Urso A, Palumbo P, Lo Storto G, Gallinaro L, Bezzi M, et al. Inguinal hernioplasty: the gold standard of hernia repair. Hernia 2003;7:35–8.
• Kulah B, Duzgun AP, Moran M, Kulacog lu IH, Ozmen MM, Coskun F. Emergency hernia repairs in elderly patients. Am J Surg 2001;182:455–9.
• Türkiye İstatistik Kurumu, Adrese Dayalı Nüfus Kayıt Sistemi Sonuçları 2011. ISBN: 978-975-19-5276-9
• Stoppa RE. The treatment of complicated groin and incisional hernias. World J Surg 1989; 13:545–54.
• Callesen T, Bech K, Kehlet H. One thousand consecutive inguinal hernia repairs under unmonitored local anesthesia. Anesth Analg 2001;93:1373-76.
• Elsebae MM, Nasr M, Said M. Tension-free repair versus Bassini technique for strangulated inguinal hernia: A controlled randomized study. Int J Surg 2008;6:302-5.
• Treviño JM, Franklin ME Jr, Berghoff KR, Glass JL, Jara millo EJ. Preliminary results of a two-layered prosthetic repair for recurrent inguinal and ventral hernias combining open and laparoscopic techniques. Hernia 2006;10:253-7.
• Abdel-Baki NA, Bessa SS, Abdel-Razek AH. Comparison of prosthetic mesh repair and tissue repair in the emergency management of incarcerated paraumbilical hernia: A prospective randomized study. Hernia 2007;11:163-7.
• The EU hernia trialists collaboration repair of groin hernia with synthetic mesh. Ann Surg 2002;235:322–32.
• Papaziogas B, Lazaridis Ch, Makris J, Koutelidakis J, Patsas A, Grigoriou M, et al. Tension-free repair versus modified Bassini technique (Andrews technique) for strangulated inguinal hernia: A comparative study. Hernia 2005;9:156-9.
• Wysocki A, Kulawik J, Pozniczek M, Strzalka M. Is the Lichtenstein operation of strangulated groin hernia a safe procedure? World J Surg 2006;30:2065-70.
• Primitesta P, Goldacre MJ. Inguinal hernia repair: Incidence of elective and emergency surgery, readmission and mortality. Int J Epidemiol 1996;25:835-9.
• Oishi SN, Page CP, Schwesinger WH. Complicated presentations of groin hernias. Am J Surg 1991;162:568-71.
• Koch A, Edwards A, Haapaniemi S, Nordin P, Kald A. Prospective evaluation of 6895 groin hernia repairs in women. Br J Surg 2005;92:1553-8.
• Chamary VL. Femoral hernias: intestinal obstruction is an unrecognized source of morbidity and mortality. Br J Surg 1993;80:230–2