Tezcan AKIN, Sabri ÖZDEN, Birkan BİRBEN, Yasin ERKUŞ, Bülent Cavit YÜKSEL, Deniz TİKİC, Hüseyin BERKEM, Merve AKIN, Sadettin ER

İnflamatuar belirteçler inkarsere inguinal hernilerde barsak nekrozunu öngörebilir mi?

Amaç: Barsak nekrozu olan inkarsere inguinal hernisi olan hastalarda inflamatuar belirteçlerin prediktif veya diagnostik değerini değerlendirmek. Gereç ve Yöntemler: Çalışmaya Ankara Numune Eğitim ve Araştırma Hastanesi Acil Servisi'ne Ocak 2013 - Ocak 2018 tarihleri arasında inkarsere inguinal herni (İİH) tanısıyla ameliyat edilen 246 hasta dahil edildi. Elektronik hasta kayıtları, lenfosit sayısı, nötrofil sayısı, nötrofil / lenfosit oranı (NLO), kırmızı hücre dağılım genişliği (RDW), trombosit sayısı ve RDW / trombosit oranını; rezeksiyon durumu ve kasık fıtığı tipiyle ilgili ameliyat notlarını ve demografik verileri elde etmek için tarandı. Çalışmaya dahil edilen hastalar barsak rezeksiyonu yapılanlar ve bu işlem yapılmayanlar olarak iki gruba ayrıldı. Bulgular: 246 hastanın 159'u (% 65) erkek, 87'si (% 35) kadındı. Ortanca yaş (çeyrekler arası aralık) rezeksiyon (n = 23) ve rezeksiyon olmayan (n = 223) gruplarda sırasıyla 71 (66-78) yıl ve 62 (50-74) yıldı. İki grup arasında yaş (p = 0.004), nötrofil sayısı (0.001), NLO (p = 0.000) ve lenfosit sayısı (p=0.000) açısından istatistiksel olarak anlamlı fark vardı. Çok değişkenli analiz, NLR'nin (olasılık oranı = 1.113, % 95 güven aralığı değeri: 1.055-1.175 ve p = 0.000) ayrı ayrı, bağımsız ve önemli ölçüde bağırsak rezeksiyonu ile ilişkili olduğunu ortaya koydu. Sonuç: İİH'li hastalarda fıtığın strangülasyonunu önlemenin mümkün olduğu düşünüldüğünde, NLO> 6.5 olan hastalara acil cerrahi girişim önerilir.

Anahtar Kelimeler:

İnkarsere İnguinal Herni, Barsak Nekrozu, İnflamatuar Belirteçler

Can bowel necrosis be predicted with inflammatory markers in incarcerated inguinal hernia?

Aim: To evaluate the predictive or diagnostic value of inflammatory markers in the presence of bowel necrosis in patients with an incarcerated inguinal hernia. Material and Methods: The sample consisted of 246 patients that were admitted to the Emergency Service of Ankara Numune Training and Research Hospital and were operated on between January 2013 and January 2018 with a diagnosis of incarcerated inguinal hernia (IIH). The electronic patient records were screened to obtain the blood test results pertaining to lymphocyte count, neutrophil count, neutrophil/lymphocyte ratio (NLR), red cell distribution width (RDW), platelet count, and RDW/platelet ratio; surgical notes concerning resection status and inguinal hernia type; and demographic data. The patients included in the study were divided into two groups as those that had received a bowel resection and those that had not undergone this procedure. Results: Of the 246 patients, 159 (65%) were male and 87 (35%) were female. The median age (interquartile range) was 71 (66-78) years and 62 (50-74) years in the resection (n= 23) and non-resection (n= 223) groups, respectively. There was a statistically significant difference between the two groups in terms of age (p= 0.004), neutrophil count (0.001), NLR (p= 0.000), and lymphocyte count (0.000). The multivariate analysis revealed that NLR (odds ratio= 1.113, 95% confidence interval value: 1.055-1.175, and p= 0.000) was individually, independently and significantly associated with bowel resection. Conclusion: Considering that it is possible to prevent the strangulation of a hernia in patients with IIH, urgent surgery is recommended for patients with an NLR of > 6.5.

Keywords:

Incarserated inguinal hernia, Bowel necrosis, inflammatory markers,

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