Murathan ERKENT, İbrahim Tayfun ŞAHİNER, Murat KENDİRCİ, Ramazan TOPÇU

İnsizyonel Herni Gelişiminde Risk Faktörlerinin Saptanması

Giriş: İnsizyonel herniler; karında uygulanan cerrahi girişimlerden sonra sık karşılaşılan sorunlardan biridir. Görülme sıklığı % 13 oranlarında bildirilmektedir. Önemli oranda iş gücü kayıplarına, morbiditeye ve hatta mortaliteye yol açıp, hayat kalitesini olumsuz yönde etkileyebilirler. Bu amaçla insizyonel herni gelişmemesi için önlem alma adına risk faktörlerini irdelemeyi amaçladık.Gereç ve Yöntem: Retrospektif olarak 2013 Kasım – 2017 Aralık tarihleri arasında kliniğimizde ameliyat edilen 128 insizyonel herni tanılı hastanın verileri analiz edildi. Hastaların demografik verileri, etyolojileri (hastalara yapılan ilk cerrahi nedenler), vücut kitle indeksleri, komorbideteleri ve ilk ameliyatı sonrasında cerrahi alan enfeksiyonu (CAE) gelişip gelişmediği gibi parametreler incelendi.Bulgular: İlk cerrahi nedenler incelendiğinde en çok %53.9 u (n:69) jinekolojik ameliyatlar ve brid ileus nedeniyle laparotomi yapılmış hastaların ameliyat edildiği gözlendi. Hastaların vücut kitle indekslerine (VKİ) bakıldığında ise %64.1 i (n:82) VKİ 25-80 olarak saptandı. Hastaların komorbiditelerine (yandaş hastalıklar) bakıldığında ise ilk sırada %38.3 (n:49) ile Kronik ostrüktif akciğer hastalığı (KOAH) saptanırken, ikinci sıklıkta %19.5 ile (25) Diyabetes Mellituslu (DM) hastalar olarak saptandı. Hastaların ilk ameliyatlarında cerrahi alan enfeksiyonu (CAE) % 87.5 (n:112) hastada CAE saptanmadı. Tartışma ve Sonuç: Yüksek VKİ ve obezite önemli nedenlerdendir. Bu çalışmada da hastaların büyük çoğunluğunu VKİ yüksek olan hastalar oluşturmaktadır. Ayrıca yandaş hastalık olarak KOAH ve DM in önemli birer hastalık olduğu ve risk faktörü oluşturduğu bu çalışmada da görülmüştür. Ayrıca bu çalışmada da 16 CAE gelişen hastada ek girişim veya medikal tedaviye rağmen insizyonel herni geliştiği gözlendi. Sonuç olarak değiştirilebilen risk faktörleri kontrol altına alınabilirse insizyonel herni gelişimi önlenebilir.

Anahtar Kelimeler:

Herni, İnsizyonel herni, Ventral

DETERMINATION OF RISK FACTORS IN INCISIONAL HERNIA DEVELOPMENT

Objective: Incisional hernias are one of the most common problems following abdominal surgical procedures, with an incidence of 13%. It can cause significant loss of labor, morbidity and even mortality and may have negative effects on the quality of life. The aim of this study was to investigate the risk factors to prevent the development of incisional hernia.Material and Method: The data of 128 patients with an incisional hernia, who underwent surgery in our clinic between 2013 and 2017, were analyzed retrospectively. Parameters including demographic data, etiology (reasons for the first surgical procedure), body mass index (BMI), comorbidities and whether surgical site infection (SSI) developed after the first operation were evaluated.Results:When the reasons for the first surgical procedure were examined, the majority of the patients were observed to consist of those who underwent a gynecological procedure and laparotomy due to brid ileus (53.9%, n= 69). Of the patients, 64.1% (n=82) were found to have a BMI of 25–80. In terms of comorbidities, 38.3% (n=49) of the patients had chronic obstructive pulmonary disease (COPD); which was followed by diabetes mellitus (DM) in 19.5% (n=25) of the patients. The rate of patients who had no SSI following the first operation was 87.5% (n=112). Discussion and Conclusion: High BMI and obesity have been found to be significant risk factors for incisional hernia. The majority of the patients in the present study were individuals with high BMI. Furthermore, COPD and DM have been found to be significant comorbidities in terms of the development of incisional hernia. Moreover, incisional hernia has developed in 16 patients with SSI despite the additional interventions or medical treatment. In conclusion, controlling the modifiable risk factors can help the prevention of the development of incisional hernia.

Keywords:

Hernia, Incisional hernia, Ventral,

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