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A single-center study on the factors affecting the surgical approach in emergent inguinal hernias

Yıl 2024, Cilt: 17 Sayı: 1, 63 - 69, 01.01.2024

Öz

Purpose: The aim is to establish the principles of surgery for patients who have undergone emergency groin hernia surgery by examining risk factors, diagnostic modalities, time to operation, and surgical techniques.
Materials and methods: A retrospective analysis was conducted on patients who underwent groin hernia repair surgery between the years 2017 and 2022. The study evaluated various parameters such as demographic characteristics, physical examination findings, co-morbidities, radiologic assessments, operation notes, time
of arrival to the hospital, and the duration of the operation. Data was collected from the hospital's electronic medical records system. Based on the mode of pre-operative assessment, patients were classified into two groups: group 1, comprising patients whose decision for surgery was based on physical examination alone, and
group 2, comprising patients who underwent radiologic assessment prior to the operation.
Result: The risk evaluation of patients who underwent emergent hernia surgery revealed a higher incidence of women gender (25%) and femoral hernia type (16.6%) as compared to the elective surgery group, where the incidence was 6.7% and 1.6%, respectively. The diagnosis of patients was primarily based on physical examination findings, although radiologic methods were used preoperatively in 75% of the cases. It was observed that radiologic assessments increased the duration of the operation and resulted in higher morbidity and intestinal resection rates.
Conclusion: Radiologic methods, apart from in cases of suspected conditions such as obesity and recurrent hernias, may lead to delayed treatment and increased morbidity and mortality rates in patients undergoing emergent hernia surgery. Prompt surgical intervention based on physical examination findings is crucial in cases
of strangulation or incarceration. In instances of spontaneous reduction, incisional exploration, hernioscopy, laparoscopy, or laparotomy should be considered if there is any suspicion of intestinal viability.

Kaynakça

  • 1. Ramsay G, Wohlgemut JM, Jansen JO. Twenty-year study of in-hospital and postdischarge mortality following emergency general surgical admission. BJS Open 2019;3:713-721. https://doi.org/10.1002/bjs5.50187
  • 2. Lebeau R, Traoré M, Anzoua KI, et al. Prognostic factors of postoperative morbidity and mortality of adult strangulated groin hernia. Indian J Surg 2016;78:192-196. https://doi.org/10.1007/s12262-015-1343-3
  • 3. Hernia Surge Group. International guidelines for groin hernia management. Hernia 2018;22:1-165. https://doi.org/10.1007/s10029-017-1668-x
  • 4. Latenstein CSS, van Wely BJ, Klerkx M, Meinders MJ, Thomeer B, de Reuver PR. Reduced elective operation rates and high patient satisfaction after the ımplementation of decision aids in patients with gallstones or an ınguinal hernia. World J Surg 2019;43:2149-2156. https://doi.org/10.1007/s00268-019-05007-w
  • 5. Bima C, Zimmitti G, Ongaro R, et al. Topic: recent innovations in hernia surgery. Hernia 2015;19:375-378. https://doi.org/10.1007/BF03355403
  • 6. Read RC. The contributions of Usher and others to the elimination of tension from groin herniorrhaphy. Hernia 2005;9:208-211. https://doi.org/10.1007/s10029-005-0322-1
  • 7. Masurkar AA. Laparoscopic Trans-Abdominal Retromuscular (TARM) repair for ventral hernia: a novel, low-cost technique for sublay and posterior component separation. World J Surg 2020;44:1081-1085. https://doi.org/10.1007/s00268-019-05298-z
  • 8. de Souza PMF, Ferreira LC, Marinari LFS, et al. Pain during and after-hernioplasty in raquidian or locorregional anesthesia by locking peripheral nerves. Hernia 2019;23:1065-1069. https://doi.org/10.1007/s10029-019-02039-y
  • 9. Bendavid R. Biography: Edward Earle Shouldice (1890-1965). Hernia 2003;7:172-177. https://doi.org/10.1007/s10029-003-0142-0
  • 10. Akin Y, Mar RL, Erturhan S, Kose O, Gorgel SN. Extraperitoneal Laparoscopic Radical Prostatectomy and Simultaneously Inguinal Hernia Repair with 3 Trocars. Int Braz J Urol 2020;46:294-295. https://doi.org/10.1590/S1677-5538.IBJU.2019.0019
  • 11. Li J, Zhang Y, Hu H, Tang W. Preperitoneal groin hernia repair with Kugel patch through an anterior approach. ANZ J Surg 2008;78:899-902. https://doi.org/10.1111/j.1445-2197.2008.04688.x
  • 12. Schoots IG, van Dijkman B, Butzelaar RM, van Geldere D, Simons MP. Inguinal hernia repair in the Amsterdam region 1994-1996. Hernia 2001;5:37-40. https://doi.org/10.1007/BF01576163
  • 13. Köckerling F, Heine T, Adolf D, et al. Trends in Emergent Groin Hernia Repair-An Analysis From the Herniamed Registry. Front Surg 2021;8:655755. https://doi.org/10.3389/fsurg.2021.655755
  • 14. Fitzgibbons RJ Jr, Giobbie-Hurder A, Gibbs JO, et al. Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial. JAMA 2006;295:285-292. https://doi.org/10.1001/jama.295.3.285
  • 15. Upchurch E, Al-Akash M. Abdominal wall herniae and their underlying pathology. Int J Surg Case Rep 2016;20:130-132. https://doi.org/10.1016/j.ijscr.2016.01.031
  • 16. Marcil G, Schendel J, Tong R, et al. The role of routine groin ultrasonography in the management of inguinal hernia. Can J Surg 2022;65:614-618. https://doi.org/10.1503/cjs.003421
  • 17. Perez AJ, Strassle PD, Sadava EE, Gaber C, Schlottmann F. Nationwide Analysis of Inpatient Laparoscopic Versus Open Inguinal Hernia Repair. J Laparoendosc Adv Surg Tech A 2020;30:292-298. https://doi.org/10.1089/lap.2019.0656
  • 18. Koizumi M, Sata N, Kaneda Y, et al. Optimal timeline for emergency surgery in patients with strangulated groin hernias. Hernia 2014;18:845-848. https://doi.org/10.1007/s10029-014-1219-7
  • 19. Kulah B, Duzgun AP, Moran M, Kulacoglu IH, Ozmen MM, Coskun F. Emergency hernia repairs in elderly patients. Am J Surg 2001;182:455-459. https://doi.org/10.1016/s0002-9610(01)00765-6
  • 20. Alvarez JA, Baldonedo RF, Bear IG, Solís JA, Alvarez P, Jorge JI. Incarcerated groin hernias in adults: presentation and outcome. Hernia 2004;8:121-126. https://doi.org/10.1007/s10029-003-0186-1
  • 21. Chen P, Huang L, Yang W, et al. Risk factors for bowel resection among patients with incarcerated groin hernias: A meta-analysis. Am J Emerg Med 2020;38:376-383. https://doi.org/10.1016/j.ajem.2019.09.023
  • 22. Ge BJ, Huang Q, Liu LM, Bian HP, Fan YZ. Risk factors for bowel resection and outcome in patients with incarcerated groin hernias. Hernia 2010;14:259-264. https://doi.org/10.1007/s10029-009-0602-2
  • 23. Pawanindra Lal, Philips P, Chander J, Ramteke VK. Is unilateral laparoscopic TEP inguinal hernia repair a job half done? The case for bilateral repair. Surg Endosc 2010;24:1737-1745. https://doi.org/10.1007/s00464-009-0841-4
  • 24. Kuhry E, van Veen RN, Langeveld HR, Steyerberg EW, Jeekel J, Bonjer HJ. Open or endoscopic total extraperitoneal inguinal hernia repair? A systematic review. Surg Endosc 2007;21:161-166. https://doi.org/10.1007/s00464-006-0167-4
  • 25. van Hessen CV, Roos MM, Sanders FBM, et al. Recurrence after totally extraperitoneal (TEP) inguinal hernia repair: the role of physical examination and ultrasound. Hernia 2020;24:153-157. https://doi.org/10.1007/s10029-019-02029-0
  • 26. Jarrard JA, Arroyo MR, Moore BT. Occult contralateral inguinal hernias: what is their true incidence and should they be repaired? Surg Endosc 2019;33:2456-2458. https://doi.org/10.1007/s00464-018-6528-y 27. Koehler RH. Diagnosing the occult contralateral inguinal hernia. Surg Endosc 2002;16:512-520. https://doi.org/10.1007/s00464-001-8166-y
  • 28. Saggar VR, Sarangi R. Occult hernias and bilateral endoscopic total extraperitoneal inguinal hernia repair: is there a need for prophylactic repair? : Results of endoscopic extraperitoneal repair over a period of 10 years. Hernia 2007;11:47-49. https://doi.org/10.1007/s10029-006-0157-4
  • 29. Rodrigues Gonçalves V, Verdaguer M, Bravo Salva A, et al. Open preperitoneal vs. open anterior repair for the treatment of emergency femoral hernia: a bicentric retrospective study. Hernia 2023;27:127-138. https://doi.org/10.1007/s10029-022-02673-z

Acil inguinal hernilerde cerrahi yaklaşıma etki eden faktörler: tek merkez deneyimi

Yıl 2024, Cilt: 17 Sayı: 1, 63 - 69, 01.01.2024

Öz

Amaç: Kasık fıtığı nedeniyle acil girişim gereken hastalarda risk faktörlerini, tanı yöntemlerini, operasyon zamanını ve tekniklerini inceleyerek cerrahi prensipleri belirlemek.
Gereç ve yöntem: 2017 ile 2022 yılları arasında kasık fıtığı onarımı ameliyatı geçiren hastalar retrospektif olarak incelendi. Çalışmada; demografik özellikler, fizik muayene bulguları, eşlik eden hastalıklar, radyolojik değerlendirmeler, operasyon notları, hastaneye varış zamanı ve operasyon süresi gibi çeşitli parametreler değerlendirildi. Veriler hastanenin elektronik tıbbi kayıt sisteminden toplandı. Hastalar, ameliyat öncesi değerlendirme şekline göre iki gruba ayrıldı: grup 1, ameliyat kararı sadece fizik muayene bulgularına dayanan hastaları içerirken; grup 2, ameliyattan önce radyolojik değerlendirmeye tabi tutulan hastaları içermekteydi.
Bulgular: Kadın cinsiyet (%25) ve femoral fıtığa (%16,6) sahip hastalarda inkarserasyon ve buna bağlı acil cerrahi gereksinimi daha yüksek oranda izlenmiştir. Hastaların tanısı genellikle fizik muayene bulgularına dayanıyordu ancak radyolojik yöntemler de vakaların %75'inde ameliyat öncesi değerlendirmede kullanıldı. Radyolojik değerlendirmelerin operasyon süresini artırdığı ve daha yüksek morbidite ve bağırsak rezeksiyonu oranlarına neden olduğu gözlemlendi.
Sonuç: Obezite ve nüks fıtık gibi şüpheli durumlar dışında, acil fıtık cerrahisi geçiren hastalarda radyolojik yöntemler, tedaviyi geciktirebilir ve morbidite ve mortalite oranlarını artırabilir. İnkarserasyon veya strangülasyon durumlarında fizik muayene bulgularına dayalı hızlı cerrahi müdahale hayati önem taşır. Spontan redüksiyon
durumlarında bağırsak canlılığına dair herhangi bir şüphe varsa eksplorasyon, hernioskopi, laparoskopi veya laparotomi düşünülmelidir.

Kaynakça

  • 1. Ramsay G, Wohlgemut JM, Jansen JO. Twenty-year study of in-hospital and postdischarge mortality following emergency general surgical admission. BJS Open 2019;3:713-721. https://doi.org/10.1002/bjs5.50187
  • 2. Lebeau R, Traoré M, Anzoua KI, et al. Prognostic factors of postoperative morbidity and mortality of adult strangulated groin hernia. Indian J Surg 2016;78:192-196. https://doi.org/10.1007/s12262-015-1343-3
  • 3. Hernia Surge Group. International guidelines for groin hernia management. Hernia 2018;22:1-165. https://doi.org/10.1007/s10029-017-1668-x
  • 4. Latenstein CSS, van Wely BJ, Klerkx M, Meinders MJ, Thomeer B, de Reuver PR. Reduced elective operation rates and high patient satisfaction after the ımplementation of decision aids in patients with gallstones or an ınguinal hernia. World J Surg 2019;43:2149-2156. https://doi.org/10.1007/s00268-019-05007-w
  • 5. Bima C, Zimmitti G, Ongaro R, et al. Topic: recent innovations in hernia surgery. Hernia 2015;19:375-378. https://doi.org/10.1007/BF03355403
  • 6. Read RC. The contributions of Usher and others to the elimination of tension from groin herniorrhaphy. Hernia 2005;9:208-211. https://doi.org/10.1007/s10029-005-0322-1
  • 7. Masurkar AA. Laparoscopic Trans-Abdominal Retromuscular (TARM) repair for ventral hernia: a novel, low-cost technique for sublay and posterior component separation. World J Surg 2020;44:1081-1085. https://doi.org/10.1007/s00268-019-05298-z
  • 8. de Souza PMF, Ferreira LC, Marinari LFS, et al. Pain during and after-hernioplasty in raquidian or locorregional anesthesia by locking peripheral nerves. Hernia 2019;23:1065-1069. https://doi.org/10.1007/s10029-019-02039-y
  • 9. Bendavid R. Biography: Edward Earle Shouldice (1890-1965). Hernia 2003;7:172-177. https://doi.org/10.1007/s10029-003-0142-0
  • 10. Akin Y, Mar RL, Erturhan S, Kose O, Gorgel SN. Extraperitoneal Laparoscopic Radical Prostatectomy and Simultaneously Inguinal Hernia Repair with 3 Trocars. Int Braz J Urol 2020;46:294-295. https://doi.org/10.1590/S1677-5538.IBJU.2019.0019
  • 11. Li J, Zhang Y, Hu H, Tang W. Preperitoneal groin hernia repair with Kugel patch through an anterior approach. ANZ J Surg 2008;78:899-902. https://doi.org/10.1111/j.1445-2197.2008.04688.x
  • 12. Schoots IG, van Dijkman B, Butzelaar RM, van Geldere D, Simons MP. Inguinal hernia repair in the Amsterdam region 1994-1996. Hernia 2001;5:37-40. https://doi.org/10.1007/BF01576163
  • 13. Köckerling F, Heine T, Adolf D, et al. Trends in Emergent Groin Hernia Repair-An Analysis From the Herniamed Registry. Front Surg 2021;8:655755. https://doi.org/10.3389/fsurg.2021.655755
  • 14. Fitzgibbons RJ Jr, Giobbie-Hurder A, Gibbs JO, et al. Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial. JAMA 2006;295:285-292. https://doi.org/10.1001/jama.295.3.285
  • 15. Upchurch E, Al-Akash M. Abdominal wall herniae and their underlying pathology. Int J Surg Case Rep 2016;20:130-132. https://doi.org/10.1016/j.ijscr.2016.01.031
  • 16. Marcil G, Schendel J, Tong R, et al. The role of routine groin ultrasonography in the management of inguinal hernia. Can J Surg 2022;65:614-618. https://doi.org/10.1503/cjs.003421
  • 17. Perez AJ, Strassle PD, Sadava EE, Gaber C, Schlottmann F. Nationwide Analysis of Inpatient Laparoscopic Versus Open Inguinal Hernia Repair. J Laparoendosc Adv Surg Tech A 2020;30:292-298. https://doi.org/10.1089/lap.2019.0656
  • 18. Koizumi M, Sata N, Kaneda Y, et al. Optimal timeline for emergency surgery in patients with strangulated groin hernias. Hernia 2014;18:845-848. https://doi.org/10.1007/s10029-014-1219-7
  • 19. Kulah B, Duzgun AP, Moran M, Kulacoglu IH, Ozmen MM, Coskun F. Emergency hernia repairs in elderly patients. Am J Surg 2001;182:455-459. https://doi.org/10.1016/s0002-9610(01)00765-6
  • 20. Alvarez JA, Baldonedo RF, Bear IG, Solís JA, Alvarez P, Jorge JI. Incarcerated groin hernias in adults: presentation and outcome. Hernia 2004;8:121-126. https://doi.org/10.1007/s10029-003-0186-1
  • 21. Chen P, Huang L, Yang W, et al. Risk factors for bowel resection among patients with incarcerated groin hernias: A meta-analysis. Am J Emerg Med 2020;38:376-383. https://doi.org/10.1016/j.ajem.2019.09.023
  • 22. Ge BJ, Huang Q, Liu LM, Bian HP, Fan YZ. Risk factors for bowel resection and outcome in patients with incarcerated groin hernias. Hernia 2010;14:259-264. https://doi.org/10.1007/s10029-009-0602-2
  • 23. Pawanindra Lal, Philips P, Chander J, Ramteke VK. Is unilateral laparoscopic TEP inguinal hernia repair a job half done? The case for bilateral repair. Surg Endosc 2010;24:1737-1745. https://doi.org/10.1007/s00464-009-0841-4
  • 24. Kuhry E, van Veen RN, Langeveld HR, Steyerberg EW, Jeekel J, Bonjer HJ. Open or endoscopic total extraperitoneal inguinal hernia repair? A systematic review. Surg Endosc 2007;21:161-166. https://doi.org/10.1007/s00464-006-0167-4
  • 25. van Hessen CV, Roos MM, Sanders FBM, et al. Recurrence after totally extraperitoneal (TEP) inguinal hernia repair: the role of physical examination and ultrasound. Hernia 2020;24:153-157. https://doi.org/10.1007/s10029-019-02029-0
  • 26. Jarrard JA, Arroyo MR, Moore BT. Occult contralateral inguinal hernias: what is their true incidence and should they be repaired? Surg Endosc 2019;33:2456-2458. https://doi.org/10.1007/s00464-018-6528-y 27. Koehler RH. Diagnosing the occult contralateral inguinal hernia. Surg Endosc 2002;16:512-520. https://doi.org/10.1007/s00464-001-8166-y
  • 28. Saggar VR, Sarangi R. Occult hernias and bilateral endoscopic total extraperitoneal inguinal hernia repair: is there a need for prophylactic repair? : Results of endoscopic extraperitoneal repair over a period of 10 years. Hernia 2007;11:47-49. https://doi.org/10.1007/s10029-006-0157-4
  • 29. Rodrigues Gonçalves V, Verdaguer M, Bravo Salva A, et al. Open preperitoneal vs. open anterior repair for the treatment of emergency femoral hernia: a bicentric retrospective study. Hernia 2023;27:127-138. https://doi.org/10.1007/s10029-022-02673-z

Ayrıntılar

Birincil Dil İngilizce
Konular Cerrahi (Diğer)
Bölüm Araştırma Makalesi
Yazarlar

Fatih BÜYÜKER 0000-0002-7567-3117

Hakan BAYSAL 0000-0003-3604-6177

Mehmet Sait ÖZSOY 0000-0003-2935-8463

Muhammet Ali AYDEMİR 0000-0003-0240-0924

Salih TOSUN 0000-0002-5033-4477

Erken Görünüm Tarihi 9 Kasım 2023
Yayımlanma Tarihi 1 Ocak 2024
Gönderilme Tarihi 6 Haziran 2023
Kabul Tarihi 9 Kasım 2023
Yayımlandığı Sayı Yıl 2024 Cilt: 17 Sayı: 1

Kaynak Göster

APA BÜYÜKER, F., BAYSAL, H., ÖZSOY, M. S., AYDEMİR, M. A., vd. (2024). A single-center study on the factors affecting the surgical approach in emergent inguinal hernias. Pamukkale Medical Journal, 17(1), 63-69.
AMA BÜYÜKER F, BAYSAL H, ÖZSOY MS, AYDEMİR MA, TOSUN S. A single-center study on the factors affecting the surgical approach in emergent inguinal hernias. Pam Tıp Derg. Ocak 2024;17(1):63-69.
Chicago BÜYÜKER, Fatih, Hakan BAYSAL, Mehmet Sait ÖZSOY, Muhammet Ali AYDEMİR, ve Salih TOSUN. “A Single-Center Study on the Factors Affecting the Surgical Approach in Emergent Inguinal Hernias”. Pamukkale Medical Journal 17, sy. 1 (Ocak 2024): 63-69.
EndNote BÜYÜKER F, BAYSAL H, ÖZSOY MS, AYDEMİR MA, TOSUN S (01 Ocak 2024) A single-center study on the factors affecting the surgical approach in emergent inguinal hernias. Pamukkale Medical Journal 17 1 63–69.
IEEE F. BÜYÜKER, H. BAYSAL, M. S. ÖZSOY, M. A. AYDEMİR, ve S. TOSUN, “A single-center study on the factors affecting the surgical approach in emergent inguinal hernias”, Pam Tıp Derg, c. 17, sy. 1, ss. 63–69, 2024.
ISNAD BÜYÜKER, Fatih vd. “A Single-Center Study on the Factors Affecting the Surgical Approach in Emergent Inguinal Hernias”. Pamukkale Medical Journal 17/1 (Ocak 2024), 63-69.
JAMA BÜYÜKER F, BAYSAL H, ÖZSOY MS, AYDEMİR MA, TOSUN S. A single-center study on the factors affecting the surgical approach in emergent inguinal hernias. Pam Tıp Derg. 2024;17:63–69.
MLA BÜYÜKER, Fatih vd. “A Single-Center Study on the Factors Affecting the Surgical Approach in Emergent Inguinal Hernias”. Pamukkale Medical Journal, c. 17, sy. 1, 2024, ss. 63-69.
Vancouver BÜYÜKER F, BAYSAL H, ÖZSOY MS, AYDEMİR MA, TOSUN S. A single-center study on the factors affecting the surgical approach in emergent inguinal hernias. Pam Tıp Derg. 2024;17(1):63-9.
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