Büyük veya komplike abdominal hernilerin tedavisinde anterior kompenent seperasyon tekniği etkili mi?

Amaç: Büyük veya komplike abdominal herniler, popülasyonun yaklaşık %0,5 ila 1'inde görülür. Bu fıtıklar anterior kompenent seperasyon tekniği ile insizyonel fıtıklar dahil olmak üzere komplike abdominal hernilerin onarımı için yaygın olarak kullanılan teknikdir. Bu çalışmanın amacı geniş defektli büyük komplike hernilerin onarımında onlay polipropilen meshli anterior komponent seperasyon tekniğini değerlendirmektir. Gereç ve Yöntem: Nisan 2018- Nisan 2021 tarihleri arasında Hitit Üniversitesi Genel Cerrahi polikliniğine başvuran komplike abdominal herni tanısı konulup anterior komponent seperasyon tekniğini ile opere edilen hastalar geriye yönelik olarak hastane sisteminden tarandı. 29 hastanın bilgilerine ulaşıldı. Hastalar yaş, cinsiyet, ASA skoru, ek hastalık sayısı, yoğun bakım ihtiyacı, preoperatif ve intraoperatif defekt çapı, postoperatif komplikasyon varlığı, cerrahi alan enfeksiyonu, seroma, cilt nekrozu, yapılan ameliyat, önceki operasyon sayısı ve etiyolojisi, mortalite, hastanede kalış süresi, takip süresi ve nüks açısından değerlendirildi. Bulgular: Çalışmaya dahil edilen 29 kişinin 13’nün erkek (%44,8), yaş ortalamaları 60,9±12,23 yıl olduğu görüldü. Hastaların 18,1 (%62,1)’i ASA 2 idi. Komplike abdominal herni tanısının en sık nedeni jinekolojik operasyonlar 10 (%34,5) idi. Hastaların biri hariç hepsine anterior komponent seperasyon tekniğini ile opere edildi. Hastaların 4 (%13,8)’ünde yoğun bakım ihtayacı ve 1 (%3,4)’inde mortalite gelişmiştir. Ortalama takip süresi 18,79±7,63 (18) ay idi. Hastanede kalış süresi ortalama 6,76±5,04 gün idi. Postoperatif komplikasyonlardan en sık 3 (%10,3) hastada seroma görüldü. Cerrahi alan enfeksiyonu ise sadece 3 (%10,3) hastada görüldü. Tüm hastaların 25 (%86,2)’ine ölü boşlukları azaltmak için subkutan dokuları mesh üzerine tespit işlemi yapıldı. Hastaların takiplerinde sadece 2 (%6,9) hastada nüks görüldü. Sonuç:Anterior komponent seperasyon tekniği, büyük insizyonel fıtıkları olan hastalar için güvenli, kolay ve hızlı bir seçenektir. Hastaların ihtiyaçlarına göre kişiselleştirilerek ve bu işlemle ilgili deneyim arttıkça komplikasyon oranı en aza indirilebilir.

Anahtar Kelimeler:

Komplike büyük herni, Anterior kompenent seperasyon tekniği, Nüks, Komplikasyon

Büyük veya komplike abdominal hernilerin tedavisinde anterior kompenent seperasyon tekniği etkili mi?

Aim: Large or complicated abdominal hernias occur in approximately 0.5 to 1% of the population. These hernias are commonly used for repair of complicated abdominal hernias , including incisional hernias, with the anterior component separation technique. The aim of this study is to evaluate the anterior component separation technique with onlay polypropylene mesh in the repair of large complicated hernias with large defects. Material and Method: Patients who were admitted to the General Surgery Outpatient Clinic of Hitit University between April 2018 and April 2021 and were diagnosed with complicated abdominal hernia and operated on with anterior component separation technique were retrospectively scanned from the hospital system. Data of 29 patients were obtained. The patients were age, gender, ASA score, number of additional diseases, need for intensive care, preoperative and intraoperative defect size, presence of postoperative complications, surgical site infection, seroma, skin necrosis, surgery performed, number of previous operations and etiology, mortality, hospitalization. Length of stay, follow-up and recurrence were evaluated. Results: Thirteen (44.8%) of the 29 people included in the study were male, with a mean age of 60.9±12.23 years. Eighteen (62.1%) of the patients were ASA 2. The most common reason for the diagnosis of complicated abdominal hernia was gynecological operations 10 (34.5%). All but one of the patients were operated with anterior component separation technique. 4 (13.8%) patients required intensive care and 1 (3.4%) mortality developed. The mean follow-up period was 18.79±7.63 (18) months. The mean hospital stay was 6.76±5.04 days. Seroma was the most common postoperative complication in 3 (10.3%) patients. surgical site infection was seen in only 3 (10.3%) patients. In 25 (86.2%) of all patients, subcutaneous tissues were fixed on the mesh to reduce dead spaces. Recurrence was observed in only 2 (6.9%) patients during the follow-up of the patients. Conclusion: Anterior component separation technique is a safe, easy and fast option for patients with large incisional hernias. Complication rates can be minimized by customizing patients' needs and increasing experience with this procedure.

Keywords:

Complicated large hernia, Anterior component separation technique, Recurrence, Complication,

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