KASIK FITIKLARINDA LİCHTENSTEİN VE DESARDA ONARIMLARININ POSTOPERATİF KRONİK AĞRI VE NÜKS YÖNÜNDEN KARŞILAŞTIRILMASI: PROSPEKTİF RANDOMİZE BİR ÇALIŞMA

Öz

Amaç Hasta konforu inguinal herni cerrahisinde başarıyı belirleyen temel unsurlardandır. Mesh kullanımı nüks sorununu ciddi şekilde çözmüş olsa da yeni bir sorun olarak kronik ağrı problemini doğurmuştur. Desarda tekniği eksternal oblik kas aponevrozunu kullanan bir yöntemdir ve fizyolojiye uyguluğun yanında düşük nüks oranları ile popülerlik kazanmıştır. Çalışmanın amacı Desarda ve Lichtenstein tekniklerinin nüks, kronik ağrı ve hasta konforu açısından karşılaştırılmasıdır. Gereç ve Yöntem Ekim 2010 ve Şubat 2014 tarihleri arasında Konya Eğitim ve Araştırma Hastanesi Genel Cerrahi Kliniği’ne kasık fıtığı şikayeti ile müracaat eden hastalar çalışmaya dahil edildi. Hastalar kapalı zarf usulü ile randomize edilerek 2 gruba ayrıldı. İlk gruba Desarda prosedürü (D),ikinci gruba Lichtenstein prosedürü (L) uygulandı. Her 2 teknik de orijinal tarif edildiği şekli ile uygulandı. Kronik ağrının değerlendirmesinde kullanılan anketler hastalara ameliyat öncesi, ameliyat sonrası 1. ve 3. yılda uygulandı. Bulgular Desarda grubunda 80,Lichtenstein grubunda 82 olmak üzere toplamda 162 hasta değerlendirmeye alındı. Ortalama takip süresi 122 (96-145) aydı. Her 2 gruptan da 2 ‘şer hastada nüks gözlendi. Ameliyat öncesi ağrı değerlendirmesinde gruplar arasında fark yoktu. Yine ameliyat sonrası 1. ve 3. yılda ağrı şiddet, sıklık ve hareket kısıtlılığında gruplar arasında anlamlı fark yoktu. Ortalama ameliyat süreleri sırasıyla 44.5±3.7 dk. ve 56.7±2.97 dk. olmak üzere D grubunda daha kısaydı. Fark istatistiksel olarak anlamlıydı( p<0.001).Gruplar arasında komplikasyonlar açısından anlamlı fark yoktu. Sonuç Desarda tekniği; dünya genelinde en sık uygulanan ve yama kullanılarak gerçekleştirilen Lichtenstein tekniği ile aynı seviyede nüks, kronik ağrı ve komplikas- yon oranı ile güvenle uygulanabilir. Dahası onarımın fizyolojiye uygun olması, yabancı cisim içermemesi, kolay öğrenilip uygulanması ve maliyet avantajı olması da yöntemin ek avantajlarıdır.

Anahtar Kelimeler

• Kasık fıtığı
• Desarda onarımı
• Lichtenstein onarımı
• kronik ağrı
• hasta konforu.

COMPARISON OF LICHTENSTEIN AND DESARDA REPAIRS IN INGUINAL HERNIAS IN TERMS OF POSTOPERATIVE CHRONIC PAIN AND RECURRENS; A PROSPECTIVE RANDOMIZED TRIAL

Öz

Objective Patient comfort is an important factor affecting the outcome and success of inguinal hernia repairs. Mesh usage significantly decreases recurrence rate however, the problems due to mesh usage negatively affects the patient comfort. Desarda repair using the body's own tissues has gained importance because it is more physiological and has low recurrence rates. In this study, we aimed to compare Desarda and Lichtenstein repairs in terms of chronic pain and recurrence. Material and Method Patients who were operated on at Konya Training and Research Hospital between October 2010 and February 2014 were included in the study. Randomization was done using the closed envelope method. Desarda repair was performed in the first group (D), and Lichtenstein repair was performed in the second group (L). Both techniques were applied as originally described. 3 questionnaires were used in the assessment of chronic pain. All three questionairres were filled before the operation, after first and third year from the operation. Results 162 people participated in the research. There were 80 people in the Desarda group and 82 in the Lichtenstein group. The median follow up time was 122 (96-145) months. There were 2 cases with recurrence in each groups. Preoperative pain levels were similar. The pain incidence, severity and limited activity were similar in the first and third years. The mean operation time was significantly lower in D group than L group (44.5±3.7 min and 56.7±2.97 min respectively). Complication rates were similar in both groups. Conclusion Desarda technique can safely used for hernia repair with its similar recurrance, complications and chronic pain rates with the most commonly used Lichtenstein technique. Moreover, it is advantageous with physiological closure of myopectineal orifice, being easy to perform, not containing foreign material and being cost-effective.

Anahtar Kelimeler

• Inguinal hernia
• Desarda repair
• chronic pain
• patient comfort.
• Lichtenstein repair

Kaynakça

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