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Comparison of Parameters Elevated Because of Stess in İnguinal Hernia Sugeries Operated with Open and Closed Techniques

Yıl 2019, Cilt: 41 Sayı: 4, 337 - 343, 01.10.2019
https://doi.org/10.20515/otd.425765

Öz

Abdominal Wall hernias are the protrusion of viscera, abdominal wall
muscles and fascia through an opening in the mesentery or around the viscera. In
this study, we aimed at comparing blood creatinine phosphokinase (CPK),
interleukin-1 (IL-1) (its release also increases in trauma), interleukin-6
(IL-6), glucose levels and white blood cell (WBC) counts between laparoscopic
total extraperitoneal (TEP) inguinal hernia repair surgery and open inguinal
hernia repair. A total of 40 patients who underwent inguinal hernia repair
surgery were included in the study. 20 out of 40 patients underwent a TEP
hernia repair and 20 underwent open inguinal hernia repair. Blood samples were
taken from the antecubital vein before the surgery, during the surgery, at hour
2 and hour 24 after the surgery and CPK, IL-1, IL-6, glucose levels and WBC
counts were measured. The comparisons between laparoscopic inguinal hernia
repair  and open inguinal hernia repair revealed that CPK levels were
significantly higher  in the TEP group than the open surgery group in
blood samples collected during the surgery (p=0.047) and at hour 2 (p=0.001)
and hour 24 after the surgery (p=0.003). During the surgical procedure, blood
glucose concentrations were significantly higher than the pre-operative values
in both open and TEP surgery groups. A significant decrease (p=0.004) was
observed in blood glucose concentrations at hour 2 after the surgery in the TEP
group, while a significant reduction was observed in blood glucose
concentrations in the open surgery group only 24 hours after the surgery
(p=0.037). No significant differences were observed between the open repair and
TEP repair groups in blood glucose concentrations (p=0.05). No significant
differences were observed between the open repair and TEP repair groups in WBC
counts (p>0.05). No significant differences were observed between the open
hernia repair and TEP groups in IL-1 and LI levels at hour 2 and hour 24 
after the surgery  (p>0,05). Blood CPK levels may increase after
surgical procedures in correlation with the severity of muscle injury. CPK
levels were higher in patients who underwent TEP hernia repair surgery than the
patients who underwent open surgery. The increases in blood glucose
concentrations and WBC counts correlated with the severity of injury and the
increase stopped in the TEP group earlier than the Open repair group.  In
conclusion, laparoscopic TEP hernia repair and open hernia repair did not
significantly differ from each other in the severity of surgical injury, based
on the parameters assessed in this study. None of the laparoscopic hernia
repair or open hernia repair is the gold standard procedure in the treatment of
inguinal hernia. Intergroup comparisons revealed that each surgical technique
had both disadvantages and advantages. We believe that the surgical technique
should be chosen based on patient’s medical state, whether the disease has
recurred, whether the patient has bilateral inguinal hernia and a surgeon’s
competence with these techniques.

Kaynakça

  • 1- Rutkow IM: Epidomiologic,economic and sociologic aspects of hernia surgery in the United States in the 1990s. Surg Clin North Am 1998;78:941-951
  • 2- Karayiannakis AJ, Makri GG, Mantzioka A Karousos D, Karatzas G: Systemic stress response cholecystectomy: a randomized trial. Br J Surg 1997; 84:467 – 471
  • 3- Webster JI, Sternberg EM. Role of the hypothalamic-pituitary-adrenal axis, glucocorticoids and glucocorticoid receptors in toxic sequelae of exposure to bacterial and viral products. J Endocrinol. 2004;181(2):207–221‏.
  • 4- Chernow B, Alexander HR, Smallridge RC, Thompon WR, Cook D Beardsley D, et al.: Hormonal responses to graded surgical stress. Arch Intern Med 1987; 147:1273 – 1278
  • 5- Wallimann, T., Wyss, M., Brdiczka, D. et al, Intracellular compartmentation, structure and function of creatine kinase isoenzymes in tissues with high and fluctuating energy demands: the 'phosphocreatine circuit' for cellular energy homeostasis. Biochem J. 1992;281:21–40.
  • 6- Kristiansson M, Saraste L, Soop M, Sundqvist KG, Thörne A: Diminished interleukin-6 and C-reactive protein responses to laparoscopic versus open cholecystectomy. Acta Anaesthesiol Scand 1999; 43:146 - 152
  • 7- Naito Y, Tamai S, Shingu K, Shindo K, Matsui T, Segava H, et al.: Responses of plasma adrenocorticotropic hormone , cortisol and cytokines during and after upper abdominal surgery. Anesthesiology 1992; 77:426 – 431
  • 8- Jakeways MSR, Mitchell V, Hashim IA, Chadwick SDJ, Shenkin A, Green CJ, et al.: Metabolic and inflammatory responses after open or laparoscopic cholecystectomy. Br J Surg 1994; 81:127 – 131
  • 9- Cruickshank AM, Fraser WD, Burns HJ, Van; Damme J, Shenkin A: Response of serum interleukin-6 in patients undergoing elective surgery of varying severity Clin Sci 190; 79:161 - 165
  • 10- Baigrie RJ, Lamont PM, Kwiatkowski D, Dallman MJ, Morris PJ: Systemic cytokine response after majör sergery. Br J surg 1992; 79:757 – 760
  • 11- Shenkin A, Fraser WD: The serum interleukin-6 response to elective surgery. Lymphokine Res 1989; 8:123 – 127
  • 12- Bellom JM, Manzano L, Bernardos L, G-Honduvilla N, Larrad A, Bujan J et al.: Cytokine levels after open and laparoscopic chlecystectomy. Eur Surg Res 1997; 29:27 – 34
  • 13- Vander VG, Penninckx F, Kerremans R, Van Damme J Arnout J: interleukin-6 and coagulation-fibrinolysis fluctuations afterlaparoscopic and conventional cholecystectomy. Surg Endosc 1994; 8:1216 – 1220
  • 14- Halevy A, Lin G, Levi R, Negri M, Evans S, Cotariu D et al.:Comparison of serum c-reactive protein concentrations for laparoscopic versus open cholecystectomy. Surg Endosc 1995; 9:280 – 282
  • 15- Redmond HP, Watson RWG, Houghton T, Condron C, Watson RGK, Bouchier Hayes D: Immune function in patients undergoing open vs laparoscopic cholecystectomy . Arch Surg 1994; 129:1240 – 1246

Açık ve Kapalı İnguinal Herni Operasyonlarında Stres Nedeniyle Yükselen Parametrelerin Karşılaştırılması

Yıl 2019, Cilt: 41 Sayı: 4, 337 - 343, 01.10.2019
https://doi.org/10.20515/otd.425765

Öz

Karın duvarı hernileri  intraabdominal
organların karın duvarı kas ve fasya tabakaları, mezenterlerin arası veya
organların çevresindeki bir açıklıktan yer değiştirmesidir . Çalışmamızda
laparoskopik total ekstraperitoneal (TEP) ve açık inguinal   herni ameliyatlarında
 kanda ( travma kaynaklıda salınımında
artış olan)interlökin 1 (IL1), interlökin 6 (IL6), kreatin fosfokinaz (CPK),
lökosit ve glukoz değerlerinin artışını karşılaştırmayı amaçladık. 
İnguinal  herni tanısıyla opere
edilen  40 hastanın 20' sine TEP diğer 20 hastaya da açık teknikle herni
operasyonu yapıldı. Olgulardan operasyon öncesi, operasyon sırasında, operasyon
sonrası ikinci ve yirmidördüncü saatlerde antekubital  venöz kan alındı. Kanda  CPK, IL1, IL6,
lökosit ve glukoz düzeylerine bakıldı.  İnguinal   hernide açık ve TEP tekniği 
karşılaştırıldığında peroperatif (p=0.047),
postoperatif ikinci saat (p=0.001), postoperatif yirmidördüncü
saatteki  (p=0,003) CPK değerleri TEP
tekniğinde anlamlı olarak daha yüksek bulundu. Glukoz değerleri, her iki grupta
da  peroperatif ameliyat öncesine göre
anlamlı olarak yükseldi. TEP operasyonunda postoperatif ikinci saatte glukoz
değeri anlamlı olarak düşerken      (p=0,004), açık teknikte
ancak postoperatif yirmidördüncü saatte anlamlı olarak düştü(p=0,037). Açık ve TEP teknikleri arasında kan glukoz düzeyleri
arasında anlamlı farklılık gözlenmedi (p=0,05). TEP operasyonuyla açık teknik
arasında kan lökosit değerleri arasında anlamlı fark gözlenmedi (p>0,05).
Açık inguinal   herni onarımı ve TEP tekniğinde preoperatif, peroperatif,
postoperatif iki, postoperatif  yirmidördüncü
saatlerde kanda IL1 ve IL6 değerlerinde anlamlı farklılık yoktu
(p>0,05). CPK değeri muskuler  travmanın derecesine bağlı olarak cerrahi
işlemlerde artar. TEP tekniği uygulanan hastalarda CPK değeri daha yüksek
saptandı. Travmanın derecesine göre artış gösteren kan glukoz ve lökosit düzeyi
yükselişi TEP yönteminde daha erken  durmuştur. Sonuçta değerlendirilen
parametrelerin hepsinde TEP veya açık yöntemin daha çok travma oluşturduğu yönünde
anlamlı bir fark saptanmadı. İnguinal herni operasyonlarında açık veya kapalı
tekniklerde gold standart yoktur. Operasyon teknikleri 
 karşılaştırıldığında birbirlerine  avantaj ve dezavantajları vardır.
Operasyon tekniği seçiminde hastanın genel durumu, nüks veya bilateral olup
olmadığına, cerrahın deneyimli olduğu tekniğe göre seçim yapılması gerektiğini
düşünüyoruz. 

Kaynakça

  • 1- Rutkow IM: Epidomiologic,economic and sociologic aspects of hernia surgery in the United States in the 1990s. Surg Clin North Am 1998;78:941-951
  • 2- Karayiannakis AJ, Makri GG, Mantzioka A Karousos D, Karatzas G: Systemic stress response cholecystectomy: a randomized trial. Br J Surg 1997; 84:467 – 471
  • 3- Webster JI, Sternberg EM. Role of the hypothalamic-pituitary-adrenal axis, glucocorticoids and glucocorticoid receptors in toxic sequelae of exposure to bacterial and viral products. J Endocrinol. 2004;181(2):207–221‏.
  • 4- Chernow B, Alexander HR, Smallridge RC, Thompon WR, Cook D Beardsley D, et al.: Hormonal responses to graded surgical stress. Arch Intern Med 1987; 147:1273 – 1278
  • 5- Wallimann, T., Wyss, M., Brdiczka, D. et al, Intracellular compartmentation, structure and function of creatine kinase isoenzymes in tissues with high and fluctuating energy demands: the 'phosphocreatine circuit' for cellular energy homeostasis. Biochem J. 1992;281:21–40.
  • 6- Kristiansson M, Saraste L, Soop M, Sundqvist KG, Thörne A: Diminished interleukin-6 and C-reactive protein responses to laparoscopic versus open cholecystectomy. Acta Anaesthesiol Scand 1999; 43:146 - 152
  • 7- Naito Y, Tamai S, Shingu K, Shindo K, Matsui T, Segava H, et al.: Responses of plasma adrenocorticotropic hormone , cortisol and cytokines during and after upper abdominal surgery. Anesthesiology 1992; 77:426 – 431
  • 8- Jakeways MSR, Mitchell V, Hashim IA, Chadwick SDJ, Shenkin A, Green CJ, et al.: Metabolic and inflammatory responses after open or laparoscopic cholecystectomy. Br J Surg 1994; 81:127 – 131
  • 9- Cruickshank AM, Fraser WD, Burns HJ, Van; Damme J, Shenkin A: Response of serum interleukin-6 in patients undergoing elective surgery of varying severity Clin Sci 190; 79:161 - 165
  • 10- Baigrie RJ, Lamont PM, Kwiatkowski D, Dallman MJ, Morris PJ: Systemic cytokine response after majör sergery. Br J surg 1992; 79:757 – 760
  • 11- Shenkin A, Fraser WD: The serum interleukin-6 response to elective surgery. Lymphokine Res 1989; 8:123 – 127
  • 12- Bellom JM, Manzano L, Bernardos L, G-Honduvilla N, Larrad A, Bujan J et al.: Cytokine levels after open and laparoscopic chlecystectomy. Eur Surg Res 1997; 29:27 – 34
  • 13- Vander VG, Penninckx F, Kerremans R, Van Damme J Arnout J: interleukin-6 and coagulation-fibrinolysis fluctuations afterlaparoscopic and conventional cholecystectomy. Surg Endosc 1994; 8:1216 – 1220
  • 14- Halevy A, Lin G, Levi R, Negri M, Evans S, Cotariu D et al.:Comparison of serum c-reactive protein concentrations for laparoscopic versus open cholecystectomy. Surg Endosc 1995; 9:280 – 282
  • 15- Redmond HP, Watson RWG, Houghton T, Condron C, Watson RGK, Bouchier Hayes D: Immune function in patients undergoing open vs laparoscopic cholecystectomy . Arch Surg 1994; 129:1240 – 1246
Toplam 15 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm ORİJİNAL MAKALELER / ORIGINAL ARTICLES
Yazarlar

Aylin Hande Gökçe 0000-0003-1908-2889

İrfan Coşkun 0000-0003-2963-0519

Feridun Suat Gökçe 0000-0001-8597-5787

Yayımlanma Tarihi 1 Ekim 2019
Yayımlandığı Sayı Yıl 2019 Cilt: 41 Sayı: 4

Kaynak Göster

Vancouver Gökçe AH, Coşkun İ, Gökçe FS. Açık ve Kapalı İnguinal Herni Operasyonlarında Stres Nedeniyle Yükselen Parametrelerin Karşılaştırılması. Osmangazi Tıp Dergisi. 2019;41(4):337-43.


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