Laparoskopik Kolesistektomi ve Transabdominal Preperitoneal Fıtık Onarımını Eş Zamanlı Yapmak Güvenli midir?

Yıl 2023, Cilt: 33 Sayı: 3, 295 - 298, 30.06.2023

Tamer Akay , Alparslan Fedayi Çalta

https://doi.org/10.54005/geneltip.1226621

Öz

Öz

Amaç: Kolesistektomi ve kasık fıtığı onarımı genel cerrahide en sık uygulanan ameliyatlardır. Laparoskopik yaklaşım ile ameliyat sonrası ağrı ve enfeksiyon riski daha düşüktür, hastalar günlük aktivitelerine daha kısa sürede dönebilir ve kozmetik görünüm daha iyidir. Ancak laparoskopik kolesistektomi ve transabdominal preperitoneal herni onarımının (TAPP) aynı anda yapıldığı cerrahi prosedürler sınırlıdır. Bu prosedürün güvenliği bu makalede sorgulanmaktadır.

Yöntem: Eşzamanlı laparoskopik kolesistektomi ve TAPP uygulanan 38 hastanın kayıtları retrospektif olarak incelendi ve hastaların demografik özellikleri, cerrahi endikasyonları, cerrahi ile ilişkili parametreler ve postoperatif komplikasyonlar ortaya çıkarıldı.

Bulgular: Hastaların yaş ortalaması 48 ± 6,7, en genç hasta 32, en yaşlı hasta 68 yaşındaydı. Hastaların ortalama ameliyat süresi 124 ± 26 dakika, ameliyat sonrası ortalama hastanede kalış süresi 2,1 ± 0,4 gün idi. İntraoperatif komplikasyon olarak bir hastada çift sistik artere bağlı kanama, bir hastada safra kesesi perforasyonu izlendi. Postoperatif dönemde bir hastada fıtık bölgesinde seroma (safra kesesi perforasyonu olan hastada), bir hastada da geç dönemde fıtık bölgesinde nüks saptandı.

Sonuçlar: Çalışmamız laparoskopik kolesistektomi ve TAPP cerrahisinin aynı anda güvenle uygulanabileceğini göstermiştir. Çalışmamızın sonuçları kolesistektomiye öncelik vermenin meş enfeksiyon oranını artırmadığını da içermektedir.

Anahtar Kelimeler

Cerrahi, herniorafi, kolesistektomi, laparoskopik, cerrahi alan enfeksiyonu.

Is It Safe to Perform Laparoscopic Cholecystectomy and Transabdominal Preperitoneal Hernia Repair Simultaneously?

Öz

Abstract

Background/Aims: Cholecystectomy and inguinal hernia repair are the most common operations in general surgery. With the laparoscopic approach, the risk of postoperative pain and infection is lower, patients can return to their daily activities in a shorter time, and the cosmetic appearance is better. However, surgical procedures in which laparoscopic cholecystectomy and transabdominal preperitoneal hernia repair (TAPP) are performed simultaneously are limited. The safety of this procedure is questioned in this article.

Methods: The records of 38 patients who had undergone simultaneous laparoscopic cholecystectomy and TAPP were retrospectively reviewed, and patient demographic characteristics, indications for surgery, parameters associated with surgery, and postoperative complications were elicited.

Results: The mean age of the patients was 48 ± 6.7 years, the youngest patient was 32 years old, and the oldest patient was 68 years old. The average operation time of the patients was 124 ± 26 minutes, and the average postoperative hospital stay was 2.1 ± 0.4 days. As for intraoperative complications, bleeding due to a double cystic artery in one patient, and perforation of the gallbladder in one patient were observed. In the postoperative period, one patient was found to have a seroma in the hernia area (in the patient with gallbladder perforation), and one patient had a recurrence in the hernia area in the late phase.

Conclusions: Our study demonstrated that laparoscopic cholecystectomy and TAPP surgery could be safely performed simultaneously. The results of our study also include that prioritizing cholecystectomy does not increase the mesh infection rate.

Anahtar Kelimeler

Surgery, herniorrhaphy, cholecystectomy, laparoscopic, surgical site infection

Kaynakça

• Kanat BH, Girgin M. Effects of Patients with Three Port Laparoscopic Cholecystectomy. J Kartal TR 2012;23(1):18-20. DOI: 10.5505/jkartaltr.2012.24392.
• Dubois F, Icard P, Berthelot G, Levard H. Coelioscopic cholecystectomy. Preliminary report of 36 cases. Ann Surg. 1990;211:60-62. DOI: 10.1097/00000658-199001000-00010.
• Litynski GS. Profiles in laparoscopy: Mouret, Dubois, and Perissat: the laparoscopic breakthrough in Europe. JSLS. 1999;3(2):163-167. PMID: 10444020 PMCID: PMC3015318.
• Ger, R. The management of certain abdominal herniae by intra-abdominal closure of the neck of the sac. Preliminary communication. Ann. R. Coll. Surg. Engl. 1982;64:342-344. PMID: 7114772 PMCID: PMC2494109.
• Arregui ME, Davis CJ, Yucel O, Nagan RF. Laparoscopic mesh repair of inguinal hernia using a preperitoneal approach: a preliminary report. Surg. Laparosc. Endosc. 1992;2:53-58. PMID: 1341501.
• Sajid MS, Caswell J, Singh KK. Laparoscopic versus open preperitoneal mesh repair of inguinal hernia: an integrated systematic review and meta-analysis of published randomized controlled trials. Indian J. Surg. 2015;77(Suppl. 3):1258-1269. DOI: 10.1007/s12262-015-1271-2.
• Quezada N, Maturana G, Pimentel E, et al. Simultaneous TAPP inguinal repair and laparoscopic cholecystectomy: results of a case series. Hernia 2019;23(1):119-123. DOI: 10.1007/s10029-018-1824-y.
• Stewart L, Grifiss JM, Jarvis GA, Way LW. Biliary bacterial factors determine the path of gallstone formation. Am J Surg 2006;192(5):598-603. DOI: 10.1016/j.amjsurg.2006.08.001.
• Kroh M, Rosenblatt S. Single-port, laparoscopic cholecystectomy and inguinal hernia repair: First clinical report of a new device. J Laparoendosc Adv Surg Tech A 2009;19:215-217. DOI: 10.1089/lap.2008.0081.
• Savita KS, Khedkar I, Bhartia VK. Combined procedures with laparoscopic cholecystectomy. Indian J Surg 2010;72(5):377-380. DOI: 10.1007/s12262-010-0117-1.
• Sarli L, Villa F, Marchesi F. Hernioplasty and simultaneous laparoscopic cholecystectomy: A prospective randomized study of open tension-free versus laparoscopic inguinal hernia repair. Surgery 2001;129:530-536. DOI: 10.1067/msy.2001.112962.
• Lehmann AJ, Piatkowski M, Nowak M, et al. Simultaneous TAPP (transabdominal pre-peritoneal technique) for inguinal hernia and cholecystectomy-a feasible and safe procedure. Pol. Przegl. Chir. 2014;86:73–76. DOI: 10.2478/pjs-2014-0013.
• Matyjas T, Kaczka K, Witas H, Ploszaj T, Matyjas K, Pomorski L. Cholelithiasis-always infected? Pol Przegl Chir 2017;89(3):23-26. PMID: 28703118.
• McCormack K, Scott N, Go PM, Ross SJ, Grant A. Collaboration the EU Hernia Trialists. Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev 2003. DOI: 10.1002/14651858.CD001785.
• Hayakawa S, Hayakawa T, Inukai K, et al. Simultaneous transabdominal preperitoneal hernia repair and laparoscopic cholecystectomy: A report of 17 cases. Asian J Endosc Surg 2019;12(4):396-400. DOI: 10.1111/ases.12667.
• Claus CMP, Ruggerı JRB, Ramos EB, et al. Simultaneous Laparoscopic Inguinal Hernia Repair And Cholecystectomy: Does it Cause Mesh Infection? ABCD Arq Bras Cir Dig 2021;34(2):e1600. DOI: 10.1590/0102-672020210002e1600.
• Liang B, Dai M, Zou Z. Safety and efficacy of antibiotic prophylaxis in patients undergoing elective laparoscopic cholecystectomy: a systematic review and meta-analysis. J. Gastroenterol. Hepatol. 2016;31:921-928. DOI: 10.1111/jgh.13246.
• Arafat S, Alsabek MB. Simultaneous laparoscopic cholecystectomy and transabdominal preperitoneal hernioplasty: two case reports evaluate the safety and surgical complications. Clinical Case Reports 2017;5(12):2093-2096. DOI: 10.1002/ccr3.1141.