Nurettin KAHRAMANSOY, Oktay BÜYÜKAŞIK, MEHMET HAYRİ ERKOL, Cavit ÇÖL

İleri yaş hastalarda lokal anestezi altında kasık fıtığı tamiri

Amaç: Yaş ilerledikçe inguinal hernilerin görülme sıklığı ve yandaş hastalık oranı artmaktadır. Bu nedenle ileri yaştaki hastalarda herniorafi sırasındaki anestezi yöntemi önem taşımaktadır. Çalışmamızın amacı, yaşlı hastaların operasyonunda lokal anestezinin uygulanabilirliğini araştırmaktı. Gereç ve yöntem: İnguinal herni tanısı ile opere edilen hastalar retrospektif olarak incelendi. Hastalar, ileri yaşlılar (>60) ve daha gençler olarak iki gruba ayrıldı. Uygulanan anestezi yöntemleri, ek anestezi gereksinimi ve komplikasyonlar karşılaştırıldı. Bulgular: Toplam 177 hastanın %30,5’i yaşlı idi. İki grup arasında operasyon tipi, anestezi yöntemi ve operasyon risk skoru belirgin farklılık gösterdi. Yaşlı olgularda, yandaş hastalık oranı (%55,6) belirgin yüksek (p< 0,001) idi. Yaşlı olgular arasında, lokal anestezi uygulanan olguların spinal-genel anestezi uygulananlara göre yandaş hastalık oranı hafif yüksekti. Lokal anesteziyi tercih oranı, genç-orta yaş olgularda %34,1 iken yaşlı olgularda %70,4 idi. Lokal anestezi yapılan ileri yaştaki bir olguda (%2,6) genel anesteziye dönüş oldu. Postoperatif komplikasyona, ileri yaşta daha sık rastlandı. İleri yaştaki komplikasyon gözlenen beş olgu (%31,3), genel-spinal anestezi yapılan olgular idi (p=0,002). Sonuç: İleri yaş hastalarda yandaş hastalık oranı ve operasyon risk skoru (ASA kategorisi) yükselmektedir. Lokal anestezi altında inguinal herniorafi, komplikasyonsuz ve genel anesteziye dönüş olmadan yapılabilir.

Inguinal hernioraphy under local anesthesia in the elderly patients

Objectives: The incidence of inguinal hernia and the frequency of comorbidity increase in the elderly. Therefore, in operations of these patients, anesthesia methods are important. The aim of our study was to investigate the feasibility of local anesthesia in the operation of the elderly. Materials and methods: The patients operated for inguinal hernia were analyzed retrospectively. They were divided into two groups: the elderly (>60 years) and the younger. Anesthesia methods, additional anesthesia requirement and complications were compared. Results: Of totally 177 patients, 30.5% were elderly. Operation type, anesthesia method and score of operational risk differed between groups. The percentage of co morbidity (55.6%) in the elderly was significantly high (p< 0.001). Among elderly, the frequency of co morbidity was slightly higher in patients who had local anesthesia compared to spinal and general anesthesia. Patients in young and middle ages preferred to be operated less under local anesthesia (34.1%) compared to elderly (70.4%). There was one case (2.6%) converted to general anesthesia as an additional anesthesia in the elderly group. Postoperative complications were slight more frequent in elderly. These cases were five in number (31.3%) and were operated under spinal or general anesthesia (p=0.002). Conclusions: The frequency of co morbidity and risk score of operation (ASA category) rise in the elderly. However, inguinal hernioraphy can be performed under local anesthesia without complication and conversion to general anesthesia.

PDF

___

1. W Sherman, JR Macho, FC Brunicardi. Inguinal hernias. In: Brunicardi FC, Andersen DK, Billiar TR, et al. eds. Schwartz’s Principles of Surgery, 9th edn. USA: Mc Graw Hill, 2010:1305-42.
2. Rogers FB, Guzman EA. Inguinal hernia repair in a community setting: implications for the elderly. Hernia 2011;15(1):37-42.
3. Alvarez Perez JA, Baldonedo RF, Bear IG, Solis JA, Alvarez P, Jorge JI. Emergency hernia repairs in elderly patients. Int Surg 2003;88(4):231-7.
4. Tingwald GR, Cooperman M. Inguinal and femoral hernia repair in geriatric patients. Surg Gynecol Obstet 1982;154(5):704-6.
5. Callesen T, Bech K, Kehlet H. One-thousand consecutive inguinal hernia repairs under unmonitored local anesthesia. Anesth Analg 2001;93(6):1373-6.
6. Kulaçoğlu İH, Polat A, Moran M, Gök R, Coşkun F. İleri yaş grubunda elektif İnguinal herni onarımı. Türk Geriatri Derg 2000;3(2):64-8.
7. Wantz GE. Atlas of hernia surgery, 1st edn. New York: Raven Press, 1991:17-23.
8. Pavlidis TE, Symeonidis NG, Rafailidis SF, et al. Tensionfree by mesh-plug technique for inguinal hernia repair in elderly patients. Scand J Surg 2010;99(3):137-41.
9. Gianetta E, De Cian F, Cuneo S, et al. Hernia repair in elderly patients. Br J Surg 1997;84(7):983-5.
10. Kulah B, Duzgun AP, Moran M, Kulacoglu IH, Ozmen MM, Coskun F. Emergency hernia repairs in elderly patients. Am J Surg 2001;182(5):455-9.
11. Alvarez Perez JA, Baldonedo RF, Bear IG, Solis JA, Alvarez P, Jorge JI. Incarcerated groin hernias in adults: presentation and outcome. Hernia 2004;8(2):121-6.
12. Kulah B, Kulacoglu IH, Oruc MT, et al. Presentation and outcome of incarcerated external hernias in adults. Am J Surg 2001;181(2):101-4.
13. Nilsson H, Nilsson E, Angerås U, Nordin P. Mortality after groin hernia surgery: delay of treatment and cause of death. Hernia 2011;15(3):301-7.
14. Lewis DC, Moran CG, Vellacott KD. Inguinal hernia repair in the elderly. J R Coll Surg Edinb 1989;34(2):101-3.
15. Ohana G, Manevwitch I, Weil R, et al. Inguinal hernia: chal- lenging the traditional indication for surgery in asymptomatic patients. Hernia 2004;8(2):117-20.
16. Paajanen H. Lichtenstein inguinal herniorraphy under local infiltration anaesthesia as rapid outpatient procedure. Ann Chir Gynecol 2001;90(215):51-4.
17. van Veen RN, Mahabier C, Dawson I, et al. Spinal or local anesthesia in lichtenstein hernia repair: a randomized controlled trial. Ann Surg 2008;247(3):428-33.
18. Nordin P, Zetterstrom H, Gunnarsson U, Nilsson E. Local, regional, or general anaesthesia in groin hernia repair: multicentre randomised trial. Lancet 2003;362(9387):853-8.
19. Yilmazlar A, Bilgel H, Donmez C, Güney A, Yilmazlar T, Tokat O. Comparision of ilioinguinal-iliohypogastric nevre block versus spinal anesthesia for inguinal herniorraphy. South Med J 2006;99(1):48-51.
20. Akinci M, Ergül Z, Kulah B, Yilmaz KB, Kulacoğlu H. Risk factors related with unfavorable outcomes in groin hernia repairs. Hernia 2010;14(5):489-93.
21. Callesen T, Bech K, Kehlet H. Feasibility of local infiltration anaesthesia for recurrent groin hernia repair. Eur J Surg 2001;167(11):851-4.
22. O’Dwyer PJ, Serpell MG, Millar K, et al. Local or general anesthesia for open hernia repair: a randomised trial. Ann Surg 2003;237(4):574-9.
23. Nordin P, Hernell H, Unosson M, Gunnarsson U, Nilsson E. Type of anaesthesia and patient acceptance in groin hernia repair: a multicentre randomised trial. Hernia 2004;8(3):220-5.
24. Ball EL, Sanjay P, Woodward A. Comparison of buffered and unbuffered local anaesthesia for inguinal hernia repair: a prospective study. Hernia 2006;10(2):175-8.
25. Kulacoglu H, Ozyaylali I, Yazicioglu D. Factors determining the doses of local anesthetic agents in unilateral inguinal hernia repair. Hernia 2009;13(5):511-6.