Ýnkarsere herni nedeni ile acil operasyon planlanan hastalarda TAPP doðru bir alternatif midir?

AMAÇ: Ýnkarsere herni acil cerrahi müdahale gereken bir tablodur. Baðýrsak iskemisinin deðerlendirilip rezeksiyon kararýnýn alýnabilmesi için inkar-sere segmentin tam olarak ortaya konmasý gerekir. Bu çalýþmada amacýmýz acile baþvurup inkarsere herni nedeniyle operasyon planlanan hastalarda yapýlan TAPP'ýn uygulanabilirliðini ortaya koymaktýr.
GEREÇ VE YÖNTEM: Çalýþma retrospektif olarak planlandý. Ocak 2015 ile Haziran 2023 tarihleri arasýnda hastanemiz acil servisine baþvurup TAPP yöntemi ile ameliyat edilen hastalar çalýþmaya dahil edildi.Tüm hastalarda laparoskopik eksplorasyon ile önce inkarsere olan segment ortaya kondu. Rezeksiyon gerekliliði deðerlendirildi. Sonrasýnda laparoskopik yöntemle herni onarýmý yapýldý. Hastalarýn demografik özellikleri, yapýlan ameliyat, baðýrsak rezeksiyon gerekliliði, postoperatif morbidite ve mortalite ve nüks yönünden sonuçlarý not edildi.
BULGULAR: Belirlenen süre içerisinde 109 hasta inkarsere herni nedeniyle baþvurdu. Baþvuran hastalardan 12’i laparoskopik cerrahiye uygun olma-dýðý veya laparoskopik ameliyat kabul etmediði için çalýþma dýþý býrakýldý. 97 hastaya TAPP uygulandý. 6 hastada anestezi indüksiyonu sonrasýnda ba-ðýrsaðýn redükte olduðu izlendi. Hastalarýn 9'unda ise baðýrsakta iskemi-nekroz izlendiði için rezeksiyon anastomoz uygulandý, 7'sinde laparoskopik, 2'sinde açýk teknik kullanýldý. Postoperatif 7 hastada seroma, 3'ünde hematoma 2'sinde ise yara enfeksiyonu görüldü. Mortalite izlenmedi. Yapýlan takiplerde 1 hastada nüks görüldü.
SONUÇ: TAPP hem inkarsere ansý deðerlendirme þansý vermesi hem de laparoskopinin avantajlarý nedeniyle seçili hastalarda acil cerrahi de uygulanabilecek bir prosedürdür.

Is TAPP the Right alternative for patients undergoing emergency surgery for incarcerated inguinal hernia?

BACKGROUND: Incarcerated inguinal hernia requires emergency intervention.The incarcerated segment should be thoroughly inspected in order to evaluate the degree of ischemia and decide whether resection is required.The aim of this study is to evaluate the applicability of TAPP for patients seen in the emergency department for incarcerated inguinal hernias.
METHODS: The study was done retrospectively.Patients who presented to the emergency department and were operated with the TAPP technique were included.Ýn all patients laparoscopic abdominal exploration was done to determine the extent of the incarcerated intestinal segment and evaluate the need for resection.TAPP technique was used to laparoscopically repair the hernia. The demographics of the patients,technique used for the hernia repair,necessity for resection,postoperative mortality and morbidity and recurrence rates were recorded.
RESULTS: 109 patients were seen for incarcerated hernia.12 patients were excluded either because they were not suitable for or did not consent to laparoscopic repair.97 patients had hernia repair with TAPP technique.Ýn 6 patients spontaneous reduction of the incarcerated segment was observed after anesthesia induction.Ýn 9 patients necrosis of the incarcerated segment was observed and re-section and anostomosis was performed.7 patients had laparoscopic 2 patients had open resections.Seroma was observed in 7, hema-toma in 3 and wound infection in 2 patients postoperatively.No mortality was seen.1 patient had a recurrence in the follow up period.
CONCLUSION: TAPP technique is a good alternative for selected patients undergoing emergency hernia repair because it provides the surgeon with the possibility to evaluate the incarcerated intestinal segment thoroughly while preserving the advantages of laparoscopic surgery.