Çocuklarda İnguinal Herni Onarımının Komplikasyonarı: 8265 Olgunun Değerlendirilmesi

Yıl 2012, Cilt: 6 Sayı: 1, 13 - 18, 01.12.2012

Tuğrul Tiryaki Müjdem Nur Azılı Fatma Özcan Ziya Livanelioğlu Evrin Mambet Fatih Akbıyık Emrah Şenel Sengül Özmert Sibel Saydam Halil Atayurt

Öz

Amaç: İnguinal herni onarımı çocuk cerrahisi pratiğinde en sık yapılan cerrahi girişim olmasına karşı herni onarımına bağlı komplikasyonlarla ilgili oldukça az yayın vardır. Çalışmamızda inguinal herni onarımı nedeni ile belirlediğimiz operatif komplikasyonlar değerlendirilerek, nedenlerinin irdelenmesi amaçlandı.Yöntem ve Gereç: 2000–2009 yılları arasında kliniğimizde inguinal herni tanısı ile opere edilen 8265 olgu hastane kayıtlarından geriye doğru değerlendirmeye alındı.Bulgular: 8265 olguda 9125 inguinal herni onarımı yapıldı. Olguların 6517’i (%78.8) erkek 1748’i (%21.2) kız idi. Operasyon yaşı 5 gün ile 20 yaş arasında idi. 125 olguda (%1.5) operatif komplikasyon ile karşılaşıldı. Operatif komplikasyon olduğu saptanan olgularımızın yaş ortalaması 2 yaş idi ve %30’unun bir yaşın altında olduğu görüldü. 55 olguda (%0.66) yara yeri enfeksiyonu belirlendi. 37 olguda (%0.44) herni nüksü saptandı. 5 olguda (% 0.07) reoperasyon gereken iatrojenik inmemiş testis gelişti. 67 olgu karşı tarafta gelişen herni nedeni ile opere edildi (%0.9).Sonuçlar: Serimizde literatürle karşılaştırıldığında komplikasyon oranının çok az olduğu görülmektedir. Diseksiyon sırasında fıtık kesesi kaçan olgularda Zigg prosedürü ile yapılan onarım nüks oranının düşük olmasının nedenidir. Kliniğimizde operasyon için bekleme süresinin olmaması, inkarsere olguların ve buna bağlı olarak komplikasyonların az görülmesini sağlamaktadır.

Anahtar Kelimeler

İnguinal herni, komplikasyon, çocuk

COMPLICATIONS OF THE INGUINAL HERNIA REPAIR IN CHILDREN: EVALUATION OF THE 8265 PATIENTS

Öz

Background: Inguinal hernia repair is the most common operation performed in pediatric surgery practise, but there are few reports about the complications of this operation. The aim of this study was to evaluate the incidence and the etiology of complications following inguinal herniotomy in chilhood.Methods: The operative and clinical notes of 8265 children operated from the begining of 2000 to the end of 2009 were reviewed retrospectively. Results: 9125 indirect inguinal hernias were repaired in 8265 patients. There were 6517 (78.8%) boys and 1748 (21.2 %) girls. The age at operation ranged from 5 days to 20 years. Operative complications were noted in 125 (1.5%) patients. The mean age of patients with operative complications was 2 years and 30% of these patients were younger than 1 year old. Among all patients with operative complications, 55 patients had wound infections (0.66%), 37 cases of recurrence was noted following hernia repair (0.44%), 5 cases of iatrogenic testicular (0.07%) ascent were required orchiopexy after hernia repair, and contralateral hernias emerged in 67 (0.9%) patients after unilateral hernia operation. Conclusions: In our series, complication rates were very low according to the literature. Use of Zigg procedure to close the hernia sac in patients with larger hernial sacs and sacs inadvertently opened during surgery decreased the recurrence rate. There is no prolonged time before surgery of inguinal hernia repair for infants in our clinic. This could be an explanation of low incarceration and also low complication rates in our series when compared to other series

Anahtar Kelimeler

Inguinal hernia, complication, childhood

Kaynakça

• Gupta DK, Rohatgi M. Inguinal hernia in children:an Indian expe- rience. Pediat Surg Int 1993;8(6):466-8.
• Harvey MH, Johnstone MJ, Fossard DP. Inguinal herniotomy in children: a five year survey. Br J Surg 1985;6(72):485-7.
• Hasan N. Management of inguinal hernia of childhood as practi- ced in Karachi Pakistan. Pediatr Surg Int 1993;8(6):462-3.
• Tiryaki T, Baskın D, Bulut M. Operative complications of hernia repair in childhood. Pediatr Surg Int 1998;13(2-3):160-1.
• Grosfeld JL. Current concepts in inguinal hernia in infants and children. World J Surg 1989;13(5):506–15.
• Rajput A, Gauderer MW, Hack M. Inguinal hernias in very low birth weight infants: incidence and timing of repair. J Pediatr Surg 1992;27(10):1322-4.
• Kumar VH, Clive J, Rosenkrantz TS, Bourque MD, Hussain N. Inguinal hernia in preterm infants. Pediatr Surg Int 2002;18(2- 3):147–52.
• Audry G, Johanet S, Achraft H, Lupold M, Gruner M. The risk of wound infection after inguinal incision in pediatric outpatient sur- gery. Eur J Pediatr Surg 1994;4(2):87-9.
• Grosfeld JL, Minnick K, Shcdd F, West KW, Rescorla FJ, Vane DW. Inguinal hernia in children: factors affecting recurrence in 62 cases. J Pediatr Surg 1991;26(3):283-7.
• Wright JE. Recurrent inguinal hernia in infancy and childhood. Pediatr Surg Int 1994;9(2):164-6
• Ein SH, Njere I, Ein A. Six thousand three hundred sixty-one pediatric inguinal hernias: a 35-year review. J Pediatr Surg 2006;41(5);980-6.
• Vogels HD, Bruijnen CJ, Beasley SW. Predictors of recurrence after inguinal herniotomy in boys. Pediatr Surg Int 2009;25(3):235-8.
• Steinau G, Treutner KH, Feeken G, Schumpelick V. Re- current inguinal hernias in infants and children.World J Surg 1995;19(2):303-6.
• Davies BW, Fraser N, Najmaldin AS, Squire BR, Crab- be DC, Stringer MD. A prospective study of neonatal inguinal herniotomy:the problem of the postoperative hydrocele. Pediatr Surg Int 2003;19(1-2):68–70.
• Wright J1, Gill, AW. Direct inguinal hernias in the newborn. Aust N Z J Surg 1991;61(3):78–81.
• Murdoch RW. Testicular strangulation from incarcerated inguinal hernia in infants. J R Coll Surg Edinb 1979;24(2:):97-101.
• Stylianos S, Jacir NN, Harris BH. Incarceration of inguinal hernia in infants prior to elective repair. J Pediatr Surg 1993;28(4):582-3.
• Rowe MI, Clatworthy HW. Incarcerated and strangulatedherni- as in children. A statistical study of high-risk factors. Arch Surg 1970;101(2):136-9.
• Palmer BV. Incarcerated inguinal hernia in children. Ann R Coll Surg Engl 1978; 60(2):121-4.
• Leung WY, Poon M, Fan TW, Siu KW, Chung KW, Kwok WK, et al. Testicular volume of boys after inguinal herniotomy: com- bined clinical and radiological follow-up. Pediatr Surg Int 1999;15(1):40-1.
• Stephens BJ, Rice WT, Koucky CJ, Gruenberg JC. Optimal ti- ming of elective indirect inguinal hernia repair in healthy child- ren: clinical considerations for improved outcome. World J Surg 1992;16(5):952-6.
• Stringer MD, Higgins M, Capps SN, Holmes SJ. Irreducible ingu- inal hernia. Br J Surg 1991;78(4):504-5.
• Puri P, Guiney EJ, O’Donnell B. Inguinal hernia in infants: the fate of the testis following incarceration. J Pediatr Surg 1984;19(1):44- 6.
• Kapur P, Caty M G, Glick PL. Pediatric hernias and hydroceles. Pediatr Clin North Am 1998;45(4):773-89.
• Chen LE, Zamakhshary M, Foglia RP, Coplen DE, Langer JC. Im- pact of wait time on outcome for inguinal hernia repair in infants. Pediatr Surg Int 2009;25(3):223-7.
• Fenig DM, Snyder HM 3rd, Wu HY, Canning DA, Huff DS. The histopathology of iatrogenic cryptorchid testis: an insight into eti- ology. J Urol 2001;165(4):1258-61.
• Surana R, Puri P. Iatrogenic ascent of the testis: an underrecog- nized complication of inguinal hernia operation in children. Br J Urol 1994;73(5):580-1.
• VanHoff J, Shaywitz BA, Seashore JH, Collins WF. Femo- ral nevre injury following inguinal hernia repair. Pediatr Neurol 1985;1(3):195-6.
• Al-Dabbagh AK. Anatomical variations of the inguinal ner- ves and risks of injury in 110 hernia repairs. Surg Radiol Anat 2002;24(2):102-7.
• Nagar H. Stitch granulomas following inguinal herniotomy: a 10- year review. J Pediatr Surg 1993;28(11):1505-7.
• Jona JZ. Letter:The neglected inguinal hernia. Pediatrics 1976;58(2):294-5.