Evaluation of Patients with Umbilical Hernia: 6 Years Experiences

Öz

Objective: Umbilical hernia is a common anterior abdominal wall defect in childhood. Although the defect is present at birth, unlike other hernias of childhood, it may close spontaneously over time without the need for surgery. However, when these hernias do not close spontaneously, complications can develop that require emergency surgery. The aim of this study was to determine the incidence of spontaneous closure in patients diagnosed with umbilical hernia and the factors that influence this incidence, the complications that may develop during follow-up, the indications for surgery and the issues to consider when planning the follow-up of patients. Material and Methods: Between January 2006 and December 2011, 1928 patients diagnosed with umbilical hernia and followed up and treated in our clinic were included in the study. In this retrospective cohort study the current size of umbilical hernia, comorbidities and demographic characteristics of the patients were analysed. Operative data, complications and postoperative follow-up of the operated patients were evaluated. Results: The spontaneous closure rate of umbilical hernia was found to be 60%. The rate of spontaneous closure of umbilical hernia was higher in boys and the rate of operation was higher in girls. The risk of incarceration was higher in girls than in boys. The rate of spontaneous closure decreased with increasing defect size. It was found that comorbidities did not affect spontaneous closure of umbilical hernias. The rate of emergency surgery for incarceration was low (2%). Strangulation was noted in 1% of patients. All patients with incarceration were in Lassaletta group 2 (defect diameter 0.5-1.5 cm). Conclusion: Conservative management is still the most accepted and safest method in the treatment of umbilical hernia. Incarceration and strangulation are very rare in umbilical hernias. Even if the umbilical hernia is complicated, surgical treatment is possible and peri- and post-operative complication rates are very low. Long-term morbidity and mortality due to incarceration have not been reported in the literature.

Anahtar Kelimeler

• Umbilical hernia
• spontaneous closure
• child
• complication.

Umblikal Hernili Hastaların Değerlendirilmesi: 6 Yıllık Deneyim

Öz

Amaç: Umblikal herni çocukluk çağında sıkça görülen karın ön duvarı defektidir. Defekt doğumda mevcut olmasına rağmen çocukluk çağının diğer hernilerinden farklı olarak ameliyat gerekmeden zamanla kendiliğinden kapanabilir. Ancak bu herniler spontan kapanmazsa acil ameliyat gerektiren komplikasyonlar gelişebilir. Bu çalışmada umblikal herni tanısı alan hastalarda spontan kapanma insidansının ve buna etki eden faktörlerin, takipte gelişebilecek komplikasyonların ve ameliyat endikasyonlarının belirlenmesi, hastaların takiplerini planlarken dikkat edilmesi gereken hususların ortaya konması amaçlanmıştır. Gereç ve Yöntemler: Kliniğimizde Ocak 2006-Aralık 2011 tarihleri arasında umblikal herni tanısı alan, takip ve tedavisi yapılan 1928 hasta çalışmaya dahil edildi. Retrospektif kohort olarak planlanan bu çalışmada hastaların mevcut umblikal herni boyutları, ek hastalıkları, demografik özellikleri incelendi. Ameliyat olan hastaların ameliyat verileri, komplikasyonları ve postoperatif takipleri değerlendirildi. Bulgular: Hastaların umblikal hernilerinin spontan kapanma oranı %60 olarak bulundu. Erkeklerde umblikal herninin spontan kapanma oranları daha yüksek olduğu, kızlarda ise ameliyat olma oranının daha yüksek olduğu görüldü. Kızlarda inkarserasyon riski erkeklere göre yüksek bulundu. Defekt boyutu arttıkça spontan kapanma oranı azalmakta olduğu görüldü. Hastalarda izlenen ek hastalıkların umblikal herninin spontan kapanmasına etkisi olmadığı saptandı. İnkarserasyon nedeniyle acil operasyon oranının (%2) düşük olduğu gözlendi. Hastaların %1’inde strangülasyon saptandı. İnkarserasyon izlenen hastaların tamamı Lassaletta grup 2’de yer almaktaydı (defekt çapı 0.5-1.5 cm). Sonuç: Umblikal herninin tedavisinde konsevatif izlem hala en kabul gören ve en güvenli yöntemdir. Umblikal hernilerde inkarserasyon ve strangülasyon oldukça nadir görülmektedir. Umblikal herni komplike hale gelmiş olsa dahi cerrahi tedavisi mümkündür ve peroperatif-postoperatif komplikasyon oranları oldukça düşüktür. İnkarserasyon nedeniyle uzun dönem morbidite ve mortalite literatürde saptanmamıştır.

Anahtar Kelimeler

• Umblikal herni
• spontan kapanma
• çocuk
• komplikasyon.

Kaynakça

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