ÖZET
Amaç: İnsizyonel herni gelişiminde rol oynayan etyolojik etkenleri araştırmak, primer tamir ile prostetik materyallerden duramater ve propilen mesh onarımlarının sonuçlarını karşılaştırmaktır. İnsizyonel herniler yüksek nüks yüzdesi nedeniyle cerrahinin sevilmeyen ameliyat grubunu oluşturur. Konvansiyonel cerrahi yöntemlerdeki yüksek nüks oranları nedeniyle cerrahlar değişik prostetik materyaller kullanmak durumunda kalmışlardır.
Gereç ve Yöntem: S.B. Ankara Eğitim ve Araştırma Hastanesi 2. Genel Cerrahi Kliniğinde Ocak 1997-Aralık 2003 arasında insizyonel herni nedeniyle ameliyat edilen yaş ortalaması 54.8 olan (31-74) 164 kadın (%74.9), 55 erkek (%25.1) toplam 219 hasta retrospektif olarak incelendi. Genel anestezi altında 194 hastaya primer fayda onarımını destekleyici olarak prolen mesh herniorafi (onlay tekniği) (%88.6), 20 hastaya primer onarım (%9.1) ve 5 hastaya duramaterle herniorafi (%2.3) yapıldı. Tüm vakalara vakumlu drenler yerleştirildi.
Bulgular: Hastalardan 57'sinde defekt 4 cm ve daha küçük, 162'sinde 4 cm'den büyüktü. Hastalarda yandaş hastalık olarak sıklık sırasına göre hipertansiyon, ateroskleroz, kronik bronşit ve prostat hipertrofisi mevcuttu. Hastaların 128'inde (%58.4) median kesiler, %6.8'inde Pfannenstiel, %5.9'unda Mc Burney, %5.9'unda subkostal insizyonlar mevcuttu. Ortalama hastanede kalış süresi 5.5 gündü. 8 ay-2 yıllık takip süresinde 27 hastada nüks gelişti (%12.3). Primer onarım yapılan %45 hastada, duramater kullanılan %20 hastada, prolen mesh kullanılan %8.8 hastada nüks gelişti. Nüks eden hastaların %81'i obezdi.
Sonuç: İnsizyonel hernilerde greftlerle yapılan onarımların, konvansiyonel onarıma göre daha etkili ve güvenilir bir yöntem olduğu, nüks gelişiminde obezite ve orta hat kesilerinin ve defekt büyüklüğünün önemli olduğu sonucuna varılmıştır.
Anahtar Kelimeler: Herni, Ventral, İnsizyonel, Mesh
The Outcomes of Incisional Hernia Surgery
ABSTRACT
Objective: We aimed to investigate the etiologic factors affecting the development of the incisional hernia and compare the outcomes of primary repair and repairing with propylene and duramater prosthesis. Incisional hernias comprises the unfavorable group of surgery because of its high recurrence rate. Surgeons have used different prosthetic materials in terms of high recurrence rate of convensional surgery methods.
Material and Method: From January 1997 to December 2003, 219 patients with incisional hernias were evaluated retrospectively at H.M. Ankara Training and Research Hospital. Our study included 164 female (74.9%) and 55 male (25.1%) patients. The mean age was 54.8 (31-74). All the operations were done under general anesthesia. Prolene mesh hernioraphi was performed in 194 patients as an onlay patch technique to buttress a tissue repair (88.6%), primary repair was performed in 20 patients (9.1%), duramater hernioraphi was performed in 5 patients (2.3%). Vacuum drains were placed in all patients.
Results: Hernia defects were smaller than 4 cm in 57 patients whereas larger than 4 cm in 162 patients. Hypertension, atherosclerosis, chronic bronchitis and prostate hypertrophy were concomitant diseases. Of the 219 patients with incisional hernias, 128 patients (58.4%) had median incisions. Pfannestiel and Mc Burney and subcostal incisions were 6.8%, 5.9%, 5.9% respectively. Mean hospitalization duration was 5.5 days. In 8 months-2 years followup time there were 27 recurrence encauntered (12.3%). Recurrence rate of the primary repair patients was 45%, recurrence rate of the duramater hernioraphy patients was 20%, recurrence rate of the propylene mesh hernioraphy patients was 8.8%. The rate of obesity in recurrent patients was 81.5%.
Conclusion: We concluded that repairing with prosthetic materials in incisional hernia surgery is more effective and reliable than repairing with convensional techniques. On the other hand, obesity and median incisions and great defects more than 4 cm are factors which were effective on the reccurrence rate.
Key Words: Hernia, Ventral, Incisional, Mesh
