Büyük veya komplike abdominal hernilerin tedavisinde anterior kompenent seperasyon tekniği etkili mi?

Yıl 2022, Cilt: 3 Sayı: 1, 50 - 54, 24.03.2022

Ramazan Topcu , Hülya Topçu

https://doi.org/10.47582/jompac.1055345

Öz

Amaç: Büyük veya komplike abdominal herniler, popülasyonun yaklaşık %0,5 ila 1'inde görülür. Bu fıtıklar anterior kompenent seperasyon tekniği ile insizyonel fıtıklar dahil olmak üzere komplike abdominal hernilerin onarımı için yaygın olarak kullanılan teknikdir. Bu çalışmanın amacı geniş defektli büyük komplike hernilerin onarımında onlay polipropilen meshli anterior komponent seperasyon tekniğini değerlendirmektir.
Gereç ve Yöntem: Nisan 2018- Nisan 2021 tarihleri arasında Hitit Üniversitesi Genel Cerrahi polikliniğine başvuran komplike abdominal herni tanısı konulup anterior komponent seperasyon tekniğini ile opere edilen hastalar geriye yönelik olarak hastane sisteminden tarandı. 29 hastanın bilgilerine ulaşıldı. Hastalar yaş, cinsiyet, ASA skoru, ek hastalık sayısı, yoğun bakım ihtiyacı, preoperatif ve intraoperatif defekt çapı, postoperatif komplikasyon varlığı, cerrahi alan enfeksiyonu, seroma, cilt nekrozu, yapılan ameliyat, önceki operasyon sayısı ve etiyolojisi, mortalite, hastanede kalış süresi, takip süresi ve nüks açısından değerlendirildi.
Bulgular: Çalışmaya dahil edilen 29 kişinin 13’nün erkek (%44,8), yaş ortalamaları 60,9±12,23 yıl olduğu görüldü. Hastaların 18,1 (%62,1)’i ASA 2 idi. Komplike abdominal herni tanısının en sık nedeni jinekolojik operasyonlar 10 (%34,5) idi. Hastaların biri hariç hepsine anterior komponent seperasyon tekniğini ile opere edildi. Hastaların 4 (%13,8)’ünde yoğun bakım ihtayacı ve 1 (%3,4)’inde mortalite gelişmiştir. Ortalama takip süresi 18,79±7,63 (18) ay idi. Hastanede kalış süresi ortalama 6,76±5,04 gün idi. Postoperatif komplikasyonlardan en sık 3 (%10,3) hastada seroma görüldü. Cerrahi alan enfeksiyonu ise sadece 3 (%10,3) hastada görüldü. Tüm hastaların 25 (%86,2)’ine ölü boşlukları azaltmak için subkutan dokuları mesh üzerine tespit işlemi yapıldı. Hastaların takiplerinde sadece 2 (%6,9) hastada nüks görüldü.
Sonuç:Anterior komponent seperasyon tekniği, büyük insizyonel fıtıkları olan hastalar için güvenli, kolay ve hızlı bir seçenektir. Hastaların ihtiyaçlarına göre kişiselleştirilerek ve bu işlemle ilgili deneyim arttıkça komplikasyon oranı en aza indirilebilir.

Anahtar Kelimeler

Komplike büyük herni, Anterior kompenent seperasyon tekniği, Nüks, Komplikasyon

Destekleyen Kurum

yok

Teşekkür

YOK

Büyük veya komplike abdominal hernilerin tedavisinde anterior kompenent seperasyon tekniği etkili mi?

Öz

Aim: Large or complicated abdominal hernias occur in approximately 0.5 to 1% of the population. These hernias are commonly used for repair of complicated abdominal hernias , including incisional hernias, with the anterior component separation technique. The aim of this study is to evaluate the anterior component separation technique with onlay polypropylene mesh in the repair of large complicated hernias with large defects.
Material and Method: Patients who were admitted to the General Surgery Outpatient Clinic of Hitit University between April 2018 and April 2021 and were diagnosed with complicated abdominal hernia and operated on with anterior component separation technique were retrospectively scanned from the hospital system. Data of 29 patients were obtained. The patients were age, gender, ASA score, number of additional diseases, need for intensive care, preoperative and intraoperative defect size, presence of postoperative complications, surgical site infection, seroma, skin necrosis, surgery performed, number of previous operations and etiology, mortality, hospitalization. Length of stay, follow-up and recurrence were evaluated.
Results: Thirteen (44.8%) of the 29 people included in the study were male, with a mean age of 60.9±12.23 years. Eighteen (62.1%) of the patients were ASA 2. The most common reason for the diagnosis of complicated abdominal hernia was gynecological operations 10 (34.5%). All but one of the patients were operated with anterior component separation technique. 4 (13.8%) patients required intensive care and 1 (3.4%) mortality developed. The mean follow-up period was 18.79±7.63 (18) months. The mean hospital stay was 6.76±5.04 days. Seroma was the most common postoperative complication in 3 (10.3%) patients. surgical site infection was seen in only 3 (10.3%) patients. In 25 (86.2%) of all patients, subcutaneous tissues were fixed on the mesh to reduce dead spaces. Recurrence was observed in only 2 (6.9%) patients during the follow-up of the patients.
Conclusion: Anterior component separation technique is a safe, easy and fast option for patients with large incisional hernias. Complication rates can be minimized by customizing patients' needs and increasing experience with this procedure.

Anahtar Kelimeler

Complicated large hernia, Anterior component separation technique, Recurrence, Complication

Kaynakça

• Dan H, Shell IV, de la Torre J, Andrades P, Vasconez LO. Open repair of ventral incisional hernias. Surg Clin N Am 2008; 88: 61–83.
• Topcu R. İnsizyonel Hernilerde Kompenent Seperasyon Tekniği. Gök MA, Kafadar MT (ed). Fıtık Cerrahisi 1. Baskı 2020: 159-79.
• Jin J, Rosen MJ. Laparoscopic versus open ventral hernia repair. Surg. Clin. North Am 2008; 88: 1083-100.
• Klinge U, Conze J, Krones CJ, Schumpelick V. Incisional hernia: open techniques . World J. Surg 2005; 29: 1066-2.
• Usher FC, Ochsner J, Tuttle Jr LL. Use of marlex mesh in the repair of incisional hernias.Am. Surg 1958; 24: 969-4.
• Eriksson A, Rosenberg J, Bisgaard T. Surgical treatment for giant incisional hernia: a qualitative systematic review. Hernia 2014; 18: 31-8.
• Pauli EM, Rosen MJ. Open ventral hernia repair with component separation. Surg Clin North Am 2013; 93: 1111-33.
• De Vries Reilingh TS, van Goor H, Charbon JA, et al. Repair of giant midline abdominal wall hernias: "components separation technique" versus prosthetic repair: interim analysis of a randomized controlled trial. World J Surg 2007; 31: 756-3.
• Ramirez OM, Ruas E, Lee Dellon A. Component separation method for closure of abdominal wall defects: An anatomic clinical study. Plast Reconstr Surg. 1990; 86: 519–6.
• De Vries Reilingh TS, van Goor H, Rosman C, et al. Component separation technique for the repair of large abdominal wall hernias. J Am Coll Surg 2003; 196: 32–7.
• Van Geffen HJ, Simmermadner RK, van Vroonhoven TJ, van der Werken C. Surgical treatment of large contaminated abdominal wall defects. J Am Coll Surg 2005; 201: 206–2.
• Liang MK, Holihan JL, Itani K, et al. Ventral hernia management: expert consensus guided by Systematic Review. Ann Surg 2016.
• Trehan M, Aggarwal K, Singh J, Singla S, Garg R. Evaluation of the component separation technique for the treatment of patients with large incisional hernia. Int J Appl Basic Med Res 2021; 11: 40-3.
• Jensen KK, Arnesen RB, Christensen JK, Bisgaard T, Jørgensen LN. Large ıncisional hernias ıncrease in size. J Surg Res 2019; 244: 160-5.
• Azar FK, Crawford TC, Poruk KE, et al. Ventral hernia repair in patients with abdominal loss of domain: an observational study of one institution's experience. Hernia 2017; 21: 245-2.
• Lindmark M, Strigård K, Löwenmark T, Dahlstrand U, Gunnarsson U. Risk factors for surgical complications in ventral hernia repair. World J Surg 2018; 42: 3528-6.
• Kesicioglu T, Yildirim K, Yuruker S, et al. Three-year outcome after anterior component separation repair of giantventral hernias: A retrospective analysis of the original technique without mesh, Asian J Surg 2021.doi.org/10.1016/j.asjsur.2021.08.017.
• Pereira-Rodriguez, JA, Bravo-Salva A, Montcusí-Ventura B, et al. Early outcomes of component separation techniques: an analysis of the Spanish registry of incisional Hernia (EVEREG). Hernia 2021; 25: 1573–0.
• Samir M, Hany M, Ibrahim M. Evaluation of component separation technique in the repair of complex large ventral hernia with large defects. Egypt J Surg 2015; 34: 272–5.
• Gonzalez R, Rehnke RD, Ramaswamy A, et al. Components separation technique and laparoscopic approach: a review of two evolving strategies for ventral hernia repair. Am Surg 2005; 71: 598-5.
• Cornette B, De Bacquer D, Berrevoet F. Component separation technique for giant incisional hernia: a systematic review. Am J Surg 2015; 215: 719-6.
• Maloney SR, Schlosser KA, Prasad T, et al. Twelve years of component separation technique in abdominal wall reconstruction. Surgery 2019; 166; 435-4.
• Clarke JM. Incisional hernia repair by fascial component separation: results in 128 cases and evolution of technique. Am J Surg 2010; 200: 2-8.
• Köckerling F. Recurrent Incisional Hernia Repair-An Overview. Frontiers in Surgery 2019; 6: 26.
• Sailes FC, Walls J, Guelig D, Mirzabeigi M, et al. Synthetic biological mesh in component separation: A 10 yr. Single institution review. Ann Plast Surg 2010; 64: 696–8.
• Hultman CS, Tong WM, Kittinger BJ, Cairns B, Overby DW, Rich PB. Management of recurrent hernia after components separation: 10-Year experience with abdominal wall reconstruction at an academic medical center. Ann Plast Surg 2011; 66: 504–7.
• Moore M, Bax T, MacFarlane M, McNevin MS. Outcomes of the fascial component separation technique with synthetic mesh reinforcement for repair of complex ventral incisional hernias in the morbidly obese. Am J Surg 2008; 195: 575-9.
• Razavi SA, Desai KA, Thompson PW, Hart AM, Losken A. The impact of mesh reinforcement with components separation for abdominal wall reconstruction. Am Surg 2018; 84: 959–2.
• Sandvall BK, Suver DW, Said HK, et al. Comparison of synthetic and biologic mesh in ventral hernia repair using components separation technique. Ann Plast Surg 2016; 76: 674–9.