BÖBREK NAKLİ HASTALARINDA İNSİZYONEL HERNİ GELİŞİMİ İÇİN RİSK FAKTÖRLERİ

Giriş: İnsizyonel herni(İH), abdominal cerrahi sonrası sık gelişen komplikasyonlardan biridir. Solid organ transplantlı hastalarda ise, İH gelişimi açısından rejeksiyonu önlemek amacıyla verilen immunosupresif tedavi nedeniyle risk artmıştır. Biz bu çalışmada böbrek nakilli hastalarda İH gelişimi ile ilişkili risk faktörlerini ortaya koymayı amaçladık. Gereç ve Yöntem: Merkezimizde Ocak 2006 ve Mayıs 2019 tarihleri arasında 599 böbrek nakilli olgunun verilerini retrospektif olarak inceledik. İH gelişen 22 hasta tespit ettik. Bu hastalara yaş, cinsiyet, vücut kitle indeksi(VKİ), donör tipi(kadavra/canlı) özellikleri açısından benzer özellikte olan ve nakil sonrası takipte İH gelişmeyen 88 hastayı kontrol grubu olarak belirledik ve bu iki gruba ait verileri istatiksel olarak karşılaştırdık. Bulgular: Herni grubunda 13(%59) hastada, kontrol grubunda ise 30(%34) hastada gecikmiş graft fonksiyonu (GGF) gelişti ve genişletilmiş kriterli donor kullanılan böbrek nakilli hasta sayısı sırasıyla 7(%31) ve 21(%23) olarak tespit edildi. Ortalama soğuk iskemi süreleri ise sırasıyla 14.2±7.1 ve 13±6.6 saatti. Cerrahi sonrası takiplerinde İH grubunda %22, kontrol grubunda ise %5 oranında cerrahi alan enfeksiyonu (CAE) tanısı kondu. Tek değişkenli analizlerde IH grubunda GGF ve CAE oranları anlamlı olarak yüksek tespit edildi (p=0.032, p=0.005). Bu iki veriyle yaptığımız çok değişkenli regresyon analizi sonucunda ise her ikisi de istatiksel olarak anlamlı olmaya devam etti(p=0.037,p=0.013). Sonuç: Böbrek nakilli hastalarda CAE ve GGF İH gelişimini artıran risk faktörleridir. Önleyici methodlar ve uygun tedavi CAE ile ilişkili IH oluşum riskini azaltabilir.

THE RISK FACTORS FOR DEVELOPMENT OF INCISIONAL HERNIA IN PATIENTS WITH KIDNEY TRANSPLANT

Introduction: Incisional hernia(IH) is a common complication following abdominal surgery. Also, patients with solid organ transplant have increased risk of developing IH due to immunosuppressive treatments to prevent rejections. In this study, we aimed to reveal the risk factors for the development of IH in patients with kidney transplant. Material and Method: We retrospectively reviewed 599 kidney transplants performed between January 2006 and May 2019 in our center. Twenty-two recipients of the 599 recipients analyzed were complicated by incisional hernias and comprised the study group. Kidney transplant recipients without incisional hernia and with similar to study group in terms of age, gender, body mass index(BMI) and donor type(cadaveric/living) constituted the control group(n=88). We compared the variables of two groups statistically. Results:Delayed graft function(DGF) developed in 13(59%) patients with IH and 30(%34) patients without IH. In study and control grup, the number of patients using extended criteria donors was 7(31%) and 21(23%) and the mean cold ischemia times were 14.2 ± 7.1 and 13 ± 6.6 hours, respectively. In the post-operative period, 22% of the IH group and 5% of the control group were diagnosed with surgical site infection (SSI). DGF and SSI were found to be significant in univariate analysis (p=0.032, p=0.005).Variables found significant in univariate analyses were entered into multivariate analyses conducted with logistic regression. Finally, we found both DGF and SSI statistically significant (p=0.037,p=0.013). Conclusion: Delayed graft function and surgical site infection are risk factors of IH following kidney transplant. Preventive methods and apropriate treatment of SSI may help to reduce the risk of incisional hernia formation due to surgical site infection.

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