Enver İLHAN, Mehmet Akif ÜSTÜNER, Fevzi CENGİZ, Savaş YAKAN, Hacı Osman TANRIVERDİ, Abdullah ŞENLİKÇİ

Laparoskopik total ekstraperitoneal kasık fıtığı tamiri konvansiyonel yönteme tercih edilebilir mi? Randomize klinik çalışma

Amaç: Bu çalışmada prospektif olarak laparoskopik totalekstraperitoneal (TEP) kasık fıtığı onarımı ile konvansiyonel Lichtenstein yöntemi karşılaştırmak amaçlanmıştır.Yöntemler: Kasık fıtıklı 50 olgu (25 konvansiyonel, 25laparoskopik) çalışmaya alındı. Prospektif olarak ameliyat öncesi olgulara ait yaş, cinsiyet, vücut kitle indeksi (BMI), kasık fıtığı türü (Nyhus sınıflaması), Amerikan Anesteziyoloji Derneği risk skorlaması (ASA), ilk cilt insizyonundan kapatılmaya kadar geçen ameliyat süreleri,peroperatif ve postoperatif komplikasyonlar, postoperatifdönemde ağrı skoru, analjezik ihtiyacı, hastanede kalış süresi, normal fizik aktiviteye dönüş süreleri ve nüks açı- sından incelenmiştir. Hastaların tümünün ağrı skorlaması için vizüel analog skala (VAS) kullanılmıştır.Bulgular: Olguların 46(%92)’si erkek olup ortalama yaş50,9 (17-78) idi. Sırası ile ortalama BMI değerleri 25,7 ve 25,8 olan gruplar arası demografik özellikler bakımından fark veya istatiksel anlamlılık yoktu (p>0,05). Her ikigrupta da ağırlıklı olarak Nyhus Tip 2 izlenmiş olup; fıtıktürü ve ASA skorları arasında istatistiksel olarak anlamlıilişki gözlenmedi (p>0,05). Laparoskopik teknik kullanılan grup, konvansiyel gruba göre operasyon süresi daha uzun olmakla birlikte; analjezik kullanımı, VAS skoru, ta-burculuk süresi ve işe dönüş zamanı bakımından dahaavantajlı görüldü (p0,05).Sonuç: Laparoskopik TEP fıtık tamiri uzun ameliyat sürelerine karşın olgunun daha az ağrı duymasını, daha az analjezik kullanımını, benzer morbidite oranı ile erken taburculuğunu sağlamaktadır.

Can laparoscopic total extraperitoneal repair of inguinal hernia be preferred to conventional method? A randomized clinical trial

Objective: This is a prospective study of laparoscopic totally extraperitoneal (TEP) inguinal hernia repair to compare with the conventional method of Lichtenstein. Methods: A total of 50 patient (25 conventional, 25 laparoscopic) with inguinal hernia were included. We were examined prospectively age, gender, body mass index (BMI), inguinal hernia type (Nyhus classification), American Society of Anesthesiologists risk score (ASA), the first skin incision until closure operation time, intraoperative and postoperative complications, postoperative pain score, analgesic requirement, hospital stay, return to normal physical activity in terms of duration and recurrence on preoperative patient. Visual analog pain score (VAS) were used for scoring pain for all patients. Results: 46 patients (92%) were male and mean age was 50.9 years (range 17-78). The mean BMI was 25,8 kg/m2 (range 19.1-31,6) and there was no significant difference in demographic characteristics between groups (p>0,05). In both groups, mainly Nyhus Type 2 was followed and there was no significant difference in ASA scores and hernia type between the groups (p>0.05). Laparoscopic group was more advantageous in analgesic use, VAS score, and return to work time, but had longer operation time (p0.05). Conclusions: Although laparoscopic TEP hernia repair had longer operation time; it provides less pain, less analgesic use with similar morbidity rate and provides early discharge.

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