Tek seansta ventral herni onarımı ile birlikte pannikülektomi de uygulanmalı mı?

Amaç: Bu çalışmanın amacı, ventral hernide eş zamanlı pannikülektomi uygulamasının postoperatif morbidite oranlarını artırıp artırmadığını araştırmaktır. Gereç ve Yöntem: Çalışma Ocak 2018- Aralık 2020 tarihleri arasında Yozgat Şehir Hastanesi Genel Cerrahi Servisinde, retrospektif olarak gerçekleştirildi. Hastaların cinsiyet, yaş, vücut kitle indeksi, yandaş hastalıkları, herni tipi ve boyutu, geçirilmiş karın cerrahisi öyküsü, ASA değeri (American Society of Anesthesiology), post-operatif komplikasyonlar, hastane yatış ve takip süreleri değerlendirildi. Post-operatif komplikasyonlar Clavien-Dindo sınıflamasına göre değerlendirildi. Bulgular: On dört hastaya eş zamanlı pannikülektomi ve ventral herni onarımı (Grup 1), 27 hastaya sadece ventral herni onarımı (Grup 2) yapıldı. Grup 1’de herni defekti alanı yaklaşık 6,25 kat daha fazlaydı. Hastane yatış süresi pannikülektomi uygulanan hastalarda anlamlı olarak daha uzundu. Ortanca takip süresi Grup 1 hastalarda 8,5 ay (2-14), diğer grupta 14 aydı (3-36). Çoklu lineer regresyon analizlerinde hastane yatış süresi üzerinde sadece herni defekt alanın anlamlı etkisi olduğu görüldü. En ciddi komplikasyon Clavien-Dindo sınıflamasına göre 3b (genel anestezi altında cerrahi müdahale) grubunda oluşan cilt nekrozuydu. Yara yeri komplikasyon ve herni rekürrensi açısından gruplar arasında anlamlı fark saptanmadı. Sonuç: Ventral herni onarımların eş zamanlı pannikülektomi uygulaması komplikasyonları ve nüks oranını artırmamaktadır. Her iki probleminden de tek seansta kurtulmak isteyen hastalara güvenle uygulanabilir.

Anahtar Kelimeler:

Ventral herni, insizyonel herni, umblikal herni, epigastrik herni, pannikülektomi

Should panniculectomy be applied with ventral hernia repair in a single session?

simultaneous panniculectomy applications in ventral hernia repair increases postoperative morbidity rates. Materials and Methods: The study was carried out retrospectively between January 2018 and December 2020. The patients were evaluated in terms of sex, age, body mass index, accompanying diseases, hernia type and size, abdominal surgery history, ASA value (American Society of Anesthesiology), postoperative complications, hospitalization, and follow-up durations. Post-operative complications were evaluated according to the Clavien-Dindo classification. Results: It was determined that 14 patients underwent simultaneous panniculectomy and ventral hernia repair (Group 1), while 27 patients underwent sole ventral hernia repair (Group 2). In Group 1, the hernia defect area was approximately 6.25-fold higher. In patients with a panniculectomy, hospitalization time was significantly longer. The median follow-up period was 8.5 months (2-14) in Group 1, and 14 months in Group 2 (3-36). In multiple linear regression analyses, only the effect hernia defect area was significant on the hospitalization time. There were no significant differences between the groups in terms of complications and hernia recurrence. Conclusion: Simultaneous panniculectomy applications in ventral hernia repairs do not increase the rate of complications and hernia recurence. A simultaneous panniculectomy application can be applied safely to patients who want to “eliminate” both of their problems in a single session.

Keywords:

Ventral hernia, incisional hernia, umbilical hernia, epigastric hernia, panniculectomy,

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