Büyük İnsizyonel Hernisi Olan Bir Hastaya Yaklaşım: Komponent Ayırma Yöntemi + Yabancı Cisim Çıkarma + Rektus Kılıfının Blok Anestezisi

Öz

Karın duvarı defektleri yaygın bir cerrahi patolojidir. Abdominal duvardaki defektin boyutunun artması abdominal duvardaki kasların fonksiyonlarının progresif bozulmasıyla ilişkilidir ve dinamik yapının kaybına yol açar. Bu durum üretkenlik kaybı ve morbiditeyle birlikte sonuç olarak yaşam kalitesinin azalmasıyla sonuçlanır. Bu defektler cerrahi pratiğinde yaygın görülmeleri ve morbidite ile ilişkili olmaları nedeniyle önemli zorluklar içermektedir. Teknik gelişmelere rağmen, tekrarlayan veya büyük fıtıklar için ideal cerrahi yaklaşım halen tartışma konusu olmaya devam etmektedir. Büyük defektleri olan hastalarda etdavi seçenekleri oldukça sınırlıdır. Ayrıca onarımı zor olan geniş anterior abdominal duvar defektlerinde cerrahi teknik gözönüne alındığında belirgin bir fikir birliği bulunmamaktadır. Son yıllarda bu tarz defektlerde seperasyon komponent yöntemi giderek artan oranlarda kullanılmaktadır. Bu yaklaşımın çoğu hasta tarfından iyi tolere edilen başarılı alternatif bir cerrahi alternatif olduğunu düşünmekteyiz.

Anahtar Kelimeler

• Ventral herni
• seperasyon komponenti
• dinamik rekonstrüksiyon

Approach to a Patient with Huge Incisional Hernia: Component Separation Method + Foreign Body Removal + Block Anesthesia of the Rectus Sheath

Öz

Abdominal wall defects represent a common surgical pathology. Increasing defect size in the abdominal wall is associated with progressive deterioration of the functions of the muscles of the abdominal wall, leading to the loss of its dynamic structure. This, in turn, results in significant loss of productivity as well as morbidity, with a consequent reduction in the quality of life. These defects remain an important challenge in surgery practice due to their common occurrence and associated morbidity. Despite technical advances, the ideal surgical approach for recurrent or huge hernias remain a matter of dispute. Therapeutic options are quite limited in patients with huge defects. Furthermore, no consensus exists regarding the surgical technique for dynamic reconstruction of the large anterior abdominal wall defects that are difficult to repair. In recent years, the “component separation” method has been increasingly used for such defects. We believe that this approach represents a successful alternative surgical therapeutic method well tolerated by most patients.

Anahtar Kelimeler

• Ventral herniation
• component separation
• dynamic reconstruction

Kaynakça

1. 1. Agnew SP, Small W, Jr., Wang E, Smith LJ, Hadad I, Dumanian GA. Prospective measurements of intra-abdominal volume and pulmonary function after repair of massive ventral hernias with the components separation technique. Annals of surgery. 2010; 251(5): 981-8.
2. 2. DuBay DA, Choi W, Urbanchek MG, Wang X, Adamson B, Dennis RG, et al. Incisional herniation induces decreased abdominal wall compliance via oblique muscle atrophy and fibrosis. Annals of surgery. 2007; 245(1):140-6.
3. 3. Ramirez OM, Ruas E, Dellon AL. "Components separation" method for closure of abdominal-wall defects: an anatomic and clinical study. Plastic and reconstructive surgery. 1990; 86(3): 519-26.
4. 4. Saulis AS, Dumanian GA. Periumbilical rectus abdominis perforator preservation significantly reduces superficial wound complications in "separation of parts" hernia repairs. Plastic and reconstructive surgery. 2002; 109(7): 2275-80.
5. 5. Rohrich RJ, Lowe JB, Hackney FL, Bowman JL, Hobar PC. An algorithm for abdominal wall reconstruction. Plastic and reconstructive surgery. 2000;1 05(1): 202-16; quiz 17.
6. 6. Anthony T, Bergen PC, Kim LT, Henderson M, Fahey T, Rege RV, et al. Factors affecting recurrence following incisional herniorrhaphy. World journal of surgery. 2000; 24(1):95-100; discussion 1.
7. 7. Leber GE, Garb JL, Alexander AI, Reed WP. Long-term complications associated with prosthetic repair of incisional hernias. Arch Surg. 1998; 133(4):378-82.