Adnan KUVVETLİ, Mehmet ÖZDOĞAN, Ebru MENEKŞE, Faruk KARATEKE, Sefa ÖZYAZICI, Safa ÖNEL

Kompleks Kas Anterior Preperitoneal Yaklaşım ık Fıtıklarının Onarımında Uygulanan

Amaç: Kasık fıtıklarının tamirinde altın standart Lichtenstein onarımıdır. Ancak nüks, dev, femoral veya kombine fıtıklar gibi kompleks fıtıkların varlığında farklı yaklaşımlar gerekir. Bu çalışmada kompleks fıtıkların tamirinde uyguladığımız anterior preperitoneal yaklaşımlı fıtık onarımı tekniğimizi sunmayı amaçladık. Materyal ve Metod: Bu çalışma Ocak 2001 ile Ağustos 2011 yılları arasında yapıldı. Çalışmaya nüks kasık fıtığı, dev inguino-skrotal, femoral veya kombine fıtığı olan hastalar dahil edildi. Hastaların demografik özellikleri, fıtık tipleri, ameliyat süreleri, ameliyat sonrası erken ve geç dönem takip sonuçları kaydedildi. Bulgular: Çalışma periyodunda 32'si erkek, 8'i kadın olmak üzere toplam 40 hastaya ameliyat tekniğimizle fıtık onarımı yapıldı. Ortalama yaş (±SS) 44±6.8 idi. Dört hastada dev direkt, 12 hastada dev inguino-skrotal fıtık, 14 hastada nüks kasık fıtığı ve 10 hastada femoral fıtık mevcuttu. 4 hasta acil şartlarda inkarserasyon nedeniyle ameliyat edildi. Ortalama ameliyat süresi (±SS) 61±11dk. idi. Ortalama 7±2.2 yıllık takip süresince hiçbir hastada nüks saptanmadı. Sonuç: Ameliyat tekniğimizde tek parça prolen yama ile myopektineal açıklıktaki olası tüm defektler kapatılarak tüm fıtık tipleri onarılabilir.

The Anterior Preperitoneal Approach for Repair of Complex Inguinal Hernias

Purpose: The gold standard for the repair of inguinal hernias is the Lichtenstein repair. However, complex inguinal hernias such as recurrent hernias, giant hernias, femoral hernias or combined hernias are present, it is necessary to choose different approaches. In this study, we aimed to present how we repair complex hernias using our open anterior preperitoneal technique. Material and Methods: Patients and Methods: The present study was carried out between the period from January 2001 through August 2011. The patients with recurrent inguinal hernia, giant inguino-scrotal, femoral or combined hernias were included. The demographics, hernia types, operation time, postoperative early and long term follow-up outcomes were recorded. Results: A total of 40 patients (Male:32, Female:8) underwent hernia repair with our technique during the study period. The mean age was (±SD) 44±6.8 years. Four patients had giant direct hernia,12 patients had giant inguino-scrotal hernia, 14 patients had recurrent and 10 patients had femoral hernia. 4 patients were underwent emergent surgery due to incarceration. The mean operation time was (±SD) 61±11 min. There was no recurrence with the mean follow-up time of 7±2.2 years. Conclusion: Our surgical technique allows to repair all types of inguinal hernia with one piece of prolene mesh by covering all potential defects.

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1. Ohana G, Manevwitch I, Weil R, Melki Y, Seror D, Powsner E et al. Inguinal hernia: challenging the traditional indication for surgery in asymptomatic patients. Hernia. 2004;8:117-20.
2. Smietanski M, Lukasiewicz J, Bigda J, Lukianski M, Witkowski P, Sledzinski Z. Factors influencing surgeons' choice of method for hernia repair technique. Hernia. 2005;9:42-5.
3. Akıncı M, Yılmaz KB, Ergül Z, Şeker D, Külah B, Kulaçoğlu H. [Emergent incarcerated groin hernias in adults: Presentations and clinical outcomes .] Ulusal Cerrahi Dergisi. 2011;27:25-30.
4. Kulacoglu H. Current options in inguinal hernia repair in adult patients. Hippokratia. 2011;15:223-23.
5. Rosenberg J, Bisgaard T, Kehlet H, Wara P, Asmussen T, Juul P et al. Danish Hernia Database. Danish Hernia Database recommendations for the management of inguinal and femoral hernia in adults. Dan Med Bull 2011;58:C4243.
6. Bisgaard T, Bay-Nielsen M, Kehlet H. Re-recurrence after operation for recurrent inguinal hernia. A nationwide 8-year follow-up study on therole of type of repair. Ann Surg. 2008;247:707-11.
7. Memon MA, Feliu X, Sallent EF, Camps J, Fitzgibbons RJ Jr. Laparoscopic repair of recurrent hernias. Surg Endosc. 1999;13:807-10.
8. Beitler JC, Gomes SM, Coelho AC. J, Manso J. E. Complex inguinal hernia repairs. Hernia. 2009;13:61- 6
9. Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, CampanelliG, Conze J, et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2009;13:343-403
10. Onat D.[İnguinal Anatomy]. Türkiye Klinikleri J Surg.1999;4:140-7.
11. Onat D. [The Advance in Inguinal Hernia Surgery]. Tür Klinikleri J Surg.1999;4:129-39
12. Maingot R. The Operations for Inguinal Hernia. In: Abdominal Operations, R. Maingot, Vol 2.Appleton Century Crofts,6.th Ed. NewYork. 1974;1479-1509.
13. Monro, AK. Femoral Hernia. In: Abdominal Operations. R. Maingot.Vol.2 Appleton Century Crofts,6.th Ed. NewYork 1974;1510-21.
14. Ponka JL. Groin hernia, Current Personal Approach. In: Hernia. Nyhus&Condon. JB Lippincott Company.2.nd Ed Philadelphia,Toronto.1978;153-62.
15. Nyhus LM. The Preperitoneal Approach and Iliopubic Tract Repair of Femoral Hernia. In: Hernia. Nyhus&Condon.JB Lippincott Company.2nd ed.1978.Philadelphia, Toronto. 163-74.
16. Glassow F. The Shouldice Repair for Unguinal Hernia. In: Hernia.Nyhus&Condon JB Lippincott Company. 2nd ed. 1978 Philadelphia,Toronto. 163- 74
17. Usher FC. Hernia Repair With Marlex Mesh. In: Hernia. Nyhus &Condon. JB.Lippincott Company.2nd ed. 1978. Philadelphia,Toronto. 561-71
18. Notaras M.J.Experience with Mersilene Mesh in Abdominal Wall Repair. In.: Hernia Nyhus&Condon. JB Lippincott Company.2.nd Ed. 1978.Philadelphia, Toronto. 571-80.
19. Moloney GE. Nylon Darn in Hernia Repair.In.Hernia.Nyhus&Condon JB Lippincott Company.2.nd ed. 1978 Philadelphia,Toronto. 581- 87
20. Yerdel MA, Türkçapar AG, Tüzüner A. [Tension free Inguinal Hernia repairs]. Tür Klinikleri J Surg. 1999;4;151-65.
21. Celdran A,Vorwald P, Merono E, Urena MA. A Single Technique for Polypropilene Mesh Hernioplasty of Inguinal and Femoral Hernias. Surg Gyn Obst. 1992;175:359-61.
22. Sevonius D, Gunnarsson U, Nordin P, Nilsson E, Sandblom G. Repeated Groin Hernia Recurrences. Ann.Surg. 2009;249:516-8.