Comprehensive Retrospective Analysis of Inguinal Hernias and Our Experiences with Special Hernias

Yıl 2024, , 110 - 115, 30.08.2024

Ramazan Serdar Arslan , Reşad Beyoğlu , Yavuz Koca , Ahmet Emre Yenipazar

https://doi.org/10.30565/medalanya.1463858

Öz

Aim: This study aims to review specific types of inguinal hernias over the past three years and analyze the surgical decision-making processes based on recent literature.

Materials and Methods: A retrospective review was conducted of 1,159 patients who underwent inguinal hernia surgery at Servergazi State Hospital between January 1, 2021, and December 31, 2023. Data analyzed included patient demographics, hernia types, locations, surgical methods, and complications. Special hernias, including Amyand's, Littre's, and Richter's hernias, were specifically identified and reviewed.

Results: Among the 1,159 patients, 113 were female (9.7%) and 1,046 were male (90.3%). The average age was 47.8 years for females and 58.6 years for males. Hernia types included 838 inguinal (72.3%), 267 femoral (23.1%), and 54 recurrent (4.6%). Specific hernias identified included 4 cases of Amyand's hernia (0.34%), 2 cases of Littre's hernia (0.17%), and 1 case of Richter's hernia (0.08%). Surgical approaches consisted of 83.7% open surgery and 16.3% laparoscopic procedures, with meshplasty performed in 96.5% of cases. Complications were infrequent: seroma in 3.9%, hematoma in 1.8%, wound infection in 2.8%, and recurrence in 0.4%. Specific hernias required additional procedures such as appendectomy for Amyand's hernia and diverticulectomy for Littre's hernia, with no complications reported during follow-up.

Conclusion: Inguinal hernias often contain omental tissue, but special hernias like Amyand's (appendix), Littre's (Meckel’s diverticulum), and Richter's (intestinal wall) necessitate thorough examination. Amyand's hernia, which can range from incidental findings to acute appendicitis, benefits from mesh repair and appendectomy if needed. Littre’s hernia requires diverticulectomy in addition to hernia repair. Richter's hernia, presenting with varied symptoms, should be managed with direct inspection and appropriate repair. The increasing use of minimally invasive techniques may lead to a higher incidence of Richter's hernia. Tailoring surgical strategies to the type of hernia ensures optimal outcomes.

Anahtar Kelimeler

inguinal hernia, Amyand's hernia, Littre's Hernia, Richter's hernia

Kasık Fıtıklarının Kapsamlı Retrospektif Analizi ve Özel Fıtıklardaki Deneyimlerimiz

Öz

Amaç: Bu çalışma inguinal herni nedeniyle son üç yılda opere edilen hastalardaki özel fıtıkları gözden geçirmek ve güncel literatüre dayalı cerrahi yönetimini ve karar alma süreçlerini analiz etmeye amaçlamaktadır.

Yöntem: 1 Ocak 2021 ile 31 Aralık 2023 tarihleri arasında Servergazi Devlet Hastanesi'nde kasık fıtığı ameliyatı geçiren 1159 hastada retrospektif olarak incelendi. Hastaların demografik verileri, fıtık tipleri, yerleşim yerleri, cerrahi yöntemler, hastanede kalış süreleri ve komplikasyonlar analiz edildi. Amyand, Littre ve Richter gibi özel fıtıklar tanımlandı ve incelendi.

Bulgular: 1159 hasta arasında 113'ü kadın (%9.7) ve 1046'sı erkekti (%90.3). Kadınlarda ortalama yaş 47.8, erkeklerde ise 58.6 idi. Fıtık tipleri arasında 838 inguinal (%72.3), 267 femoral (%23.1) ve 54 nüks herni (%4,6) idi. Belirlenen spesifik fıtıklar dört Amyand (%0,34), iki Littre (%0,17) ve bir Richter (%0,08) herni idi. Cerrahi yaklaşımlar %83,7 açık ve %16,3 laparoskopikti; vakaların %96,5'inde greftli onarım yapılmıştı. Komplikasyonlar oranları düşüktü; %3.9'unda seroma, %1,8'inde hematom, %2,8'inde yara enfeksiyonu ve %0,4'ünde nüks herni görüldü. Spesifik fıtıklar, Amyand için apendektomi ve Littre için divertikülektomi ile birlikte greftli onarım tercih edilmişti. Richter hernisine mesh plug uygulanmıştı. Spesifik fıtıkların 10.gün ve birinci ay takiplerinde hiçbir komplikasyon bildirilmedi.

Sonuç: İnguinal hernilerde fıtık kesesi içerisinde sıklıkla omental doku bulunur, ancak Amyand (apandisit), Littre (Meckel divertikülü) ve Richter (bağırsak duvarı) gibi özel fıtıklar dikkatli inceleme gerektirir. Herni kesesi içerisinde saptanan dokuya göre tedavi stratejisi değişmektedir. Greftli veya anatomik onarım cerrahın peroperatif bulgularına göre karar vermesi gereken bir durumdur.

Anahtar Kelimeler

Amyand fıtığı, Littre fıtığı, Richter fıtığı, inguinal herni

Kaynakça

• 1. Tran HM, MacQueen I, Chen D, Simons M. Systematic Review and Guidelines for Management of Scrotal Inguinal Hernias. J Abdom Wall Surg. 2023;2:11195. doi: 10.3389/jaws.2023.11195.
• 2. Stabilini C, van Veenendaal N, Aasvang E, Agresta F, Aufenacker T, Berrevoet F, et al. Update of the international HerniaSurge guidelines for groin hernia management. BJS Open. 2023;7(5):zrad080 doi: 10.1093/bjsopen/zrad080.
• 3. Cirocchi R, Burini G, Avenia S, Tebala G, Palumbo P, Cianci MC, et al. Asymptomatic inguinal hernia: does it need surgical repair? A systematic review and meta-analysis. ANZ J Surg. 2022 ;92(10):2433–41. doi: 10.1111/ans.17594.
• 4. Marcolin P, Mazzola Poli de Figueiredo S, Moura Fé de Melo V, Walmir de Araújo S, Mota Constante M, Mao RMD, et al. Mesh repair versus non-mesh repair for incarcerated and strangulated groin hernia: an updated systematic review and meta-analysis. Hernia. 2023;27(6):1397–413. doi: 10.1007/s10029-023-02874-0.
• 5. Pawlak M, East B, de Beaux AC. Algorithm for management of an incarcerated inguinal hernia in the emergency settings with manual reduction. Taxis, the technique and its safety. Hernia. 2021;25(5):1253–8. doi: 10.1007/s10029-021-02429-1.
• 6. Bains HK, Agostinho N, Hamilton AE, Byrne C. What is in the sac? Littré hernia. ANZ J Surg. 2020;90(5):896–8. doi: 10.1111/ans.15353.
• 7. Seok D, Akrawe S, Mittal V. Littre’s hernia-a reason for resection. J Surg Case Rep. 2023;2023(1):rjac617. doi: 10.1093/jscr/rjac617.
• 8. Manatakis DK, Tasis N, Antonopoulou MI, Anagnostopoulos P, Acheimastos V, Papageorgiou D, et al. Revisiting Amyand’s Hernia: A 20‐Year Systematic Review. World J Surg. 2021;45(6):1763–70. doi: 10.1007/s00268-021-05983-y.
• 9. Lee CH, Chien LJ, Shen CY, Su YJ. Amyand’s hernia. Am J Med Sci. 2022;364(4):e8–9. doi: 10.1016/j.amjms.2022.05.006.
• 10. Fischer DI, Rivin M, Perry ZH. A Port Site Richter’s Hernia. Am Surg. 2023;89(4):1147–8. doi: 10.1177/0003134820979186.
• 11. Bayeh A, Limenh S. Richter’s Type Recurrent Indirect Inguinal Hernia, an Extremely Rare Occurrence: A Case Report. Open Access Emerg Med. 2022;14:323–6. doi: 10.2147/OAEM.S363212.
• 12. Patoulias D, Kalogirou M, Patoulias I. Amyand’s Hernia: an Up-to-Date Review of the Literature. Acta Medica (Hradec Kralove). 2017;60(3):131–4. doi: 10.14712/18059694.2018.7.
• 13. Michalinos A, Moris D, Vernadakis S. Amyand’s hernia: a review. American J Surg. 2014;207(6):989–95. doi: 10.1016/j.amjsurg.2013.07.043.
• 14. Losanoff JE, Basson MD. Amyand hernia: a classification to improve management. Hernia. 2008;12(3):325–6. doi: 10.1007/s10029-008-0331-y.
• 15. Singal R, Mittal A, Gupta A, Gupta S, Sahu P, Sekhon MS. An incarcerated appendix: report of three cases and a review of the literature. Hernia. 2012;16(1):91–7. doi: 10.1007/s10029-010-0715-7.
• 16. Balani A, Marda SS, Alwala S, Reddy SP, Kumar AD, Devu S. Perforated Littre’s hernia diagnosed on imaging: case report and review of literature. Jpn J Radiol. 2015 ;33(6):366–9. doi: 10.1007/s11604-015-0422-5. 17. Răcăreanu M, Preda SD, Preda A, Strâmbu VDE, Radu PA, Bratiloveanu TC, et al. Management of Littre Hernia-Case Report and Systematic Review of Case Reports. J Clin Med. 2023;12(11):3743. doi: 10.3390/jcm12113743.
• 18. Schizas D, Katsaros I, Tsapralis D, Moris D, Michalinos A, Tsilimigras DI, et al. Littre’s hernia: a systematic review of the literature. Hernia. 2019;23(1):125–30. doi: 10.1007/s10029-018-1867-0.
• 19. Boughey JC, Nottingham JM, Walls AC. Richter’s hernia in the laparoscopic era: four case reports and review of the literature. Surg Laparosc Endosc Percutan Tech. 2003;13(1):55–8. doi: 10.1097/00129689-200302000-00014.
• 20. Birhanu AM, Mohammed SH, Mohammed SM, Abebe TM, Sequr BY. Incarcerated Richter’s congenital umbilical hernia in a young male: A case report. Int J Surg Case Rep. 2023;109:108576. doi: 10.1016/j.ijscr.2023.108576.
• 21. Chorti A, AbuFarha S, Michalopoulos A, Papavramidis TS. Richter’s hernia in a 5-mm trocar site. SAGE Open Med Case Rep. 2019;7:2050313X18823413. doi: 10.1177/2050313X18823413.
• 22. Schmuter G, Narula N, Mukherjee I. Rare Presentation of Incarcerated Incisional Richter’s Hernia of the Cecum. Cureus. 2021;13(8):e16971. doi: 10.7759/cureus.16971.