Bülent KAYA, MEHMET VELİDEDEOĞLU, Rahmi HATİPOĞLU, Kamil Mehmet YILDIZ

Results of different surgical techniques in inguinal hernia repair

Amaç: İnguinal herni, cerrahi pratiğinde en sık karşılaşılan problemlerden biridir. Çeşitli teknikler tamirde kullanılmaktadır. Son yıllarda Lichtenstein herniorafi gerilimsiz bir yöntem olarak popüler hale gelmiştir. Bu çalışmada inguinal herni tamirinde değişik cerrahi tekniklerin sonuçlarını incelemeyi amaçladık. Materyal ve Metot: Şubat 2002 ile Ocak 2010 tarihleri arasında inguinal herni tanısı ile opere edilen 189 hasta retrospektif olarak incelendi. Beş değişik cerrahi teknik (Bassini, Shouldice, Ağ örme, Lichtenstein ve Laparoskopik herniorafi) inguinal herni tamirinde kullanıldı. Hastaların yaşı, cinsiyeti, operasyon bilgileri,erken ve geç komplikasyonlar, visual analog skorları, hastanede kalışsüresi, kronik ağrı ve nüks gelişimi incelendi. Bulgular: Bu çalışmada 179 erkek ve 10 kadın hasta mevcuttu. Ortalama yaş 29,2 (14-79 arası). Uygulanan cerrahi teknikler Bassini (74 hasta), Shouldice (14 hasta), Ağ örme (15 hasta), Lichtenstein (77 hasta), laparoskopik herniorafi (9 hasta). En kısa operasyon süresi ağ örme grubundaydı. Yine bu grupta en düşük visual analog skala skoru ve en erken işe geri dönme tespit edildi. En sık görülen komplikasyon skrotal ödemdi. Lichtenstein grubunda bir hastada iatrojenik ileum yaralanması görüldü. Bassini grubunda 3 (%4), Lichtenstein grubunda 2 (%2,6) hastada nüks tespit edildi. Sonuç: Lichtenstein ameliyatı ve ağ örme tekniği postoperatif ağrı, işe erken geri dönme ve nüks açısından diğer tekniklere üstün görünmektedir.

İnguinal herni tamirinde değişik cerrahi tekniklerin sonuçları

Objective: Inguinal hernia is one of the most commonly encountered problem in surgical practice. The different repair techniques were performed for a long time. The Lichtenstein herniorrhaphy as a tension-free method, has gained popularity in last years. We aimed to demonstrate the results of our experience with different surgical techniques in inguinal hernia repair. Material and Methods: A series of 189 patients operated with inguinal hernia in between February 2002 to January 2010 were studied retrospectively. Five different surgical techniques (Bassini, Shouldice, Plication darn, Lichtenstein and Laparoscopic herniorrhaphy) were performed for inguinal hernia . The patient's age, sex, operation details, early and late complications, visual analog scores, duration of hospital stay, occurence of chronic pain and recurrence rates were collected. Results: There were 179 men and 10 women in this study. The mean age was 29.2 (range 14-79) years. The performed surgical techniques were Bassini (74 patients), Shouldice repair (14 patients), plication darn (15 patients), Lichtenstein technique (77 patients) and laparoscopic herniography (9 patients). The shortest operation time was detected in Plication darn group. It is also associated with lower visual analog scale scores and early return to work. The most common early complication was scrotal edema. There was an iatrogenic ileum perforation in Lichtenstein repair. There were 3 (4%) recurrence in Bassini repair and 2 recurrence (2.6%) in Lichtenstein technique. Conclusion: Lichtenstein repair and plication darn seem to have better results in terms of postoperative pain, early return to work and recurrences rates in inguinal hernia repair.

PDF

___

Kurzer M, Belsham PA, Kark AE. The Lichtenstein repair. Surg Clin North Am 1998;78(6):1025-1046
Amid PK, Shulman AG, Lichtenstein IL. Open "Tension-Free" repair of inguinal hernias; The Lichtenstein technique. Eur J Surg 1996;162(6): 447-53.
Goldstein HS. Selecting the right mesh. Hernia 1999;3:23-26
Kark AE, Kurzer M, Waters KJ. Tension-free mesh hernia repair: review of 1098 cases using local anaesthesia in a day unit. Ann R Coll Surg Engl 1995;77(4):299-304.
Shouldice EE. Surgical treatment of hernia. Ontario Med Rev 1953; 20:670684
Kark AE, Kurzer MN, Belsham PA. Three thousand one hundred seventy five primary inguinal hernia repairs: advantages of ambulatory open mesh repair using local anesthesia. J Am Coll Surg 1998;186(4):447 55.
Bay-Nielsen M, Nordin P, Nilsson E, Kehlet H. Danish Hernia Data Base and the Swedish Hernia Data Base. Operative findings in recurrent hernia after a Lichtenstein procedure. Am J Surg 2001;182(2):1346.
Stephenson BM. Complications of open groin hernia repairs. Surg Clin North Am 2003;83(5):125578.
Koukourou A, Lyon W, Rice J, Wattchow DA. Prospective randomized trial of polypropylene mesh compared with nylon darn in inguinal hernia repair. Br J Surg 2001;88(7):931-4.
Papaziogas B, Lazaridis Ch, Makris J, Koutelidakis A, Patsas M Grigoriou, et al. Tensionfree repair versus modified Bassini technique (Andrews technique) for strangulated inguinal hernia: a comparative study. Hernia 2005;9(2):156-9.
Miyazaki K, Nakamura F, Narita Y, Dohke M, Kashimura N, Matsunami O, et al. Comparison of Bassini repair and mesh-plug repair for primary inguinal hernia: a retrospective study. Surg Today 2001;31(7): 610-4.
Zsult B, Csiky M. Reccurences rate in Bassini operation after five years. Magy Seb 2001;54(5):307-8.
EU Hernia Trialists Collaboration. Mesh compared with non-mesh methods of open groin hernia repair: systematic review of randomized controlled trials. Br J Surg 2000;87(7):854-9.
Zeybek N, Tas H, Peker Y, Yildiz F, Akdeniz A, Tufan T. Comparison of modified darn repair and Lichtenstein repair of primary inguinal hernias. J Surg Res 2008;146(2):225-9
Moloney GE. Results of nylon-darn repairs of hernia. Lancet 1958;1(7015):45-8.
Lifschutz H, Juler GL. The inguinal darn. Arch Surg 1986;121(6): 717-9.
El-Bakry AA. Plication darn for the repair of inguinal hernia. A university hospital experience. Saudi Med J 2002;23(11):1347-9.
Ali N, Israr M, Isman M. Recurrence after primary inguinal hernia repair: mesh versus darn. Pak J Surg 2008;24(3):153-5.
Shouldice EB. The Shouldice natural tissue repair for inguinal hernia. BJU Int 2010;105(3):428-39.
Amato B, Moja L, Panico S, Persico G, Rispoli C, Rocco N, et al. Shouldice technique versus other open techniques for inguinal hernia repair. Cochrane Database Syst Rev 2009;7(4): CD001543.
Butters M, Redecke J, Köninger J. Long-term results of a randomized clinicaltrial of Shouldice, Lichtenstein and transabdominal preperitoneal hernia repairs. Br J Surg 2007;94(5):562-5.
Berndsen FH, Petersson U, Arvidsson D, Leijonmarck CE, Rudberg C, Smedberg S, Montgomery A. SMIL Study Group. Discomfort five years after laparoscopic and Shouldice inguinal hernia repair: a randomised trial with 867 patients. A report from the SMIL study group. Hernia 2007;11(4): 307-13.