KARIN ÖN DUVARI FITIKLARININ TAMİRİNDE AÇIK VE LAPAROSKOPİK YÖNTEMLERİN SONUÇLARININ KARŞILAŞTIRILMASI

Öz

Amaç: Bu çalışmada, kliniğimizde son dört sene içerisinde karın ön duvarı fıtığı nedeniyle laparoskopik ve açık yöntemlerle ameliyat edilen hastaların sonuçları karşılaştırıldı.

Gereç ve Yöntem: Ocak 2012 ve Ocak 2016 tarihleri arasında kliniğimizde karın ön duvarı fıtığı nedeniyle ameliyat edilen ve verileri kayıt edilen 76 olgunun verileri retrospektif olarak incelendi. Karın ön duvarı fıtıkları (kesi yeri fıtığı ve ventral herniler) dışında inguinal, femoral veya Spiegel gibi diğer karın duvarı fıtıkları nedeniyle ameliyat edilen hastalar çalışmaya alınmadı. Yama kullanılmadan primer tamir uygulanarak ameliyat edilen tüm karın duvarı fıtıkları da çalışmaya alınmadı. Çalışmaya dahil edilen 76 hasta, ameliyatı laparoskopik olarak bitirilen 43 hasta, grup 1 (n:43, %56,5 ), onlay teknik ile yama yerleştirilen hastalar ise grup 2 (n:33, %43,5) olarak tanımlandı. Olgular, demografik veriler, vücut kitle indeksi (VKİ), onarım yöntemleri, ameliyat süreleri, hastanede kalış süreleri ve ameliyat sonrası komplikasyonlar açısından değerlendirildi.

Bulgular: Ameliyata laparoskopik olarak başlanılan 44 hastadan 43’ünün ameliyatı laparoskopik olarak, 33 hastanın ameliyatı ise açık cerrahi teknik ile bitirildi. İki grubun demografik verileri arasında anlamlı bir fark saptanmadı. Laparoskopik grupta ameliyat süresi açık gruba oranla anlamlı olarak daha yüksek bulundu. Buna karşılık hastanede kalış süresi anlamlı olarak daha düşük bulundu. Ameliyat esnasında ve sonrasında gelişen genel komplikasyon oranları karşılaştırıldığında Grup 2’de anlamlı şekilde daha fazla komplikasyon geliştiği saptandı. Nüksü etkileyen faktörler karşılaştırıldığında ise laparoskopik ve açık teknik arasında fark olmadığı, ancak geçirilmiş fıtık cerrahisinin nüks için önemli bir risk faktörü olduğu saptandı.

Sonuç: Çok büyük ventral herniler (≥15cm) dışında laparoskopinin güvenli bir şekilde, yüksek hasta memnuniyeti ile birlikte güvenli bir şekilde uygulanabileceği kanaatindeyiz.

Anahtar kelimeler: Karın ön duvarı fıtığı; ventral herni; insizyonel herni; kesi fıtığı; herniorafi; laparoskopik tamir.

Anahtar Kelimeler

• Karın ön duvarı fıtığı,ventral herni,insizyonel herni,kesi fıtığı,herniorafi,laparoskopik tamir

COMPARISON OF RESULTS OF LAPAROSCOPIC AND OPEN REPAIR TECHNIQUES IN VENTRAL AND INCISIONAL HERNIAS

Öz

Objective: In this study, we compared the results of patients who underwent laparoscopic and open ventral and incisional hernia repair in our clinic during last four years.

Materials and Methods: The data of 76 patients who underwent surgery for ventral and incisional hernia between January 2012 and January 2016 in our clinic were analyzed retrospectively. The patients who underwent surgery for other types of abdominal wall hernias (such as inguinal, femoral, Spiegelian etc.) and patients who underwent primary repair without use of mesh were excluded. Forty-three patients (n: 43, 56,5%) whose operation was completed laparoscopically were defined as group1 and 33 patients (n:33, %43,5) who were operated using mesh with onlay technique were defined as group2. The cases were evaluated in terms of demographic data, body mass index (BMI), repair procedures, operation time, duration of hospital stay and postoperative complications.

Results: In 44 patients, operation was initiated laparoscopically and in 43 were completed laparoscopically, whereas 33 patients were operated by open surgical technique. There was no significant difference in demographic data between these two groups. In the laparoscopic group, the operation time was significantly higher than the open group. However, the duration of hospital stay was significantly shorter. When the general complication rates during and after the surgery were compared, it was found that group 2 had significantly more complications. When the factors affecting recurrence were compared, it was found that there was no difference between laparoscopic and open techniques, but the history of a previous hernia operation was an important risk factor for recurrence.

Conclusion: In our opinion laparoscopy can be safely performed with high patient satisfaction except in cases with very large ventral hernias (≥15 cm).

Keywords: Abdominal wall hernia; ventral hernia; incisional hernia; hernioraphy; laparoscopic repair.

Anahtar Kelimeler

• Abdominal wall hernia,ventral hernia,incisional hernia,hernioraphy,laparoscopic repair

Kaynakça

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