İsmail Ege SUBAŞI, Metin YÜCEL, Mustafa HASBAHÇECİ, Fatih BAŞAK, ORHAN ALİMOĞLU

İnguinal herninin günübirlik cerrahisi: Cerrahi asistanları tarafından lokal anestezi altında gerçekleştirilen Lichtenstein inguinal herni onarımı

Amaç: Lokal anestezi ile günü birlik cerrahi olarak uygulanan Lichtenstein inguinal herni onarımı, cerrahi eğitim programı kapsamın yapılan eğitimlerin başında gelmektedir. Bu çalışmada, asisten hekimlerin yaptığı bu ameliyatı incelemeyi amaçladık.Gereç ve Yöntemler: Primer inguinal herni tanısı alan 40 yaş ve üstü erkek hastalar, Haziran 2009-Mart 2011 arasında ileriye dönük olarak çalışmaya dahil edildi. Tekrarlama ve kronik postoperatif ağrı açısından cerrahi sonuçlar çalışıldı.Bulgular: Yaş ortalaması 55,7±10,8 olan 151 hasta vardı. İntraoperatif değerlendirme 84 (%55,6) direk fıtık, 58 (%38,4) indirekt ve dokuz (%6,0) direk-indirekt fıtık birlikteliği vardı. Ortalama operasyon süresi 51,2 ±13,2 dakikaydı ve bu obez hastalarda anlamlı derecede yüksekti (p<0,05). Postoperatif dönemde 143 (%94,7) hasta, ilk sekiz saat içinde taburcu edildi. Hastaların çoğu (%90,7) lokal anesteziyi tekrar seçeceğini ifade etti. Onbir hastanın ağrı skoru 6. ve 12. ay değerlendirmelerinde 0,23±0,7 (dağılım 0-4) ve 0,07±0,4 (dağılım 0-3) olarak tespit edildi. Postoperatif 1. günde, 137 (%90,7) hasta günlük aktivitelerine geri döndü. 28 (%18,5) hematom ve seroma oluşumu ve 18 (%11,9) yara enfeksiyonu vardı. Mesh reaksiyonu saptanmadı; Ancak bir yıl operasyondan sonra iki (%1.3) rekürrens tespit edildi.Sonuç: Lichtenstein inguinal herni onarımı, lokal anestezi altında günlük cerrahi girişim olarak birincil tedavi yöntemi olarak seçilmeli ve ameliyat asistanlar tarafından gözetim altında güvenli bir şekilde yapılabilir.Anahtar kelimeler: İnguinal herni onarımı, Lokal anestezi, Günübirlik cerrahi

Anahtar Kelimeler:

Fıtık onarımı, Lokal anestezi, Günü birlik cerrahi

Day-case surgery for inguinal hernia: Lichtenstein inguinal hernia repair under local anesthesia performed by surgical residents.

Background: Lichtenstein inguinal hernia repair with local anesthesia as a day-case surgery is one of aspects of education in inguinal hernia surgery as a surgical training program. In this study, we aimed to present these surgery performed by residents. Methods: Forty years and older male patients diagnosed as primary inguinal hernia were included prospectively between June 2009 and March 2011. Surgical outcomes with respect to recurrence and chronic postoperative pain were studied.Results: There were 151 patients with a mean age of 55.7±10.8. Intraoperative evaluation revealed direct in 84 (55.6%), indirect in 58 (38.4%) and combined hernia in 9 (6.0%). Mean operation time was 51.2±13.2 minutes which was significantly higher in obese patients (p<0.05). Patients were discharged at postoperatively 8 hours or less in 143 (94.7%). Most of the patients (90.7%) were reported to choose local anesthesia again. Eleven and four patients reported pain scores of 0.23±0.7 (range 0-4) and 0.07±0.4 (range 0-3) at 6th and 12th month evaluations, respectively. At the postoperative 1st day, 137 (90.7%) patients could return to daily activities. There were 28 (18.5%) hematoma and seroma formation, and 18 (11.9%) wound infection. There was no mesh reaction; however, 2 (1.3%) recurrences were detected after one year of the operation. Conclusions: Lichtenstein inguinal hernia repair under local anesthesia as a day case surgery should be chosen as a primary treatment method, and can be performed by surgical residents under supervision in a safe manner.

Keywords:

Hernia repair, Local anesthesia, Day-case surgery,

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1. Koch A, Bringman S, Myrelid P, et al (2008) Randomized clinical trial of groin hernia repair with titanium-coated lightweight mesh compared with standard polypropylene mesh. Br J Surg 95:1226-1231.
2. van Hanswijck de Jounge P, Lloyd A, Horsfall L, et al (2008) The measurement of chronic pain and health-related quality of life following inguinal hernia repair: a review of the literature. Hernia 12:561-569.
3. Liem MSL, van Duyn EB, van der Graaf Y, et al (2003) Recurrences After Conventional Anterior and Laparoscopic Inguinal Hernia Repair. Ann Surg 237:136-141.
4. Pokorny H, Klingler A, Schmid T, et al (2008) Recurrence and complications after laparoscopic versus open inguinal hernia repair: results of a prospective randomized multicenter trial. Hernia 12:385-389.
5. Reid TD, Sanjay P, Woodward A (2009) Local Anesthetic Hernia Repair in Overweight and Obese Patients. World J Surg 33:138-141.
6. Smietanski M (2008) Randomized clinical trial comparing a polypropylene with a poliglecaprone and polypropylene composite mesh for inguinal hernioplasty. Br J Surg 95:1462-1468.
7. Aasvang EK, Kehlet H (2009) The effect of mesh removal and selective neurectomy on persistent postherniotomy pain. Ann Surg 249:327-334.
8. Agarwal BB, Agarwal KA, Mahajan KC (2009) Prospective double-blind randomized controlled study comparing heavy-and lightweight polypropylene mesh in totally extraperitoneal repair of inguinal hernia: early results. Surg Endosc 23:242-247.
9. Paajanen H, Varjo R (2010) Ten-year audit of Lichtenstein hernioplasty under local anaesthesia performed by surgical residents. BMC Surg 10:24.
10. Dalenback J, Andersson C, Anesten B, et al (2009) Prolene Hernia System, Lichtenstein mesh and plug-and-patch for primary inguinal hernia repair: 3-year outcome of a prospective randomised controlled trial. Hernia 13:121-129.