Ulus Travma Acil Cerrahi Derg. 2012; 18(5): 389-396 | DOI: 10.5505/tjtes.2012.48827

Boðulmuþ abdominal duvar herni cerrahisi: Morbidite ve mortalite insidansýnýn risk faktörleriyle iliþkisinin analizi (Tek merkezli acil cerrahi deneyimi)

Erkan Özkan, Mehmet Kamil Yýldýz, Tuðrul Çakýr, Ender Dulundu, Cengiz Eriþ, Mehmet Mahir Fersahoðlu, Ümit Topaloðlu
Ýstanbul Haydarpaþa Numune Eðitim Ve Araþtýrma Hastanesi, 5. Genel Cerrahi Kliniði, Ýstanbul, Türkiye

AMAÇ
Bu çalýþmada, acil cerrahi kliniðimizde boðulmuþ abdominal duvar hernisi nedeniyle ameliyat edilen hastalarda morbidite ve mortaliteyle iliþkili risk faktörlerinin insidansý araþtýrýldý.
GEREÇ VE YÖNTEM
Hastalar hem fýtýk türüne göre (inguinal, umblikal, insizyonel, femoral) kendi aralarýnda hem de morbidite ve mortalite üzerine etkili faktörler bakýmýndan; yaþ, cinsiyet, Amerikan Anesteziyoloji Derneði (AAD) skoru, anestezi tipi, eþlik eden hastalýklar, intestinal boðulma ve nekroz varlýðý gibi verilerle deðerlendirildi.
BULGULAR
Ýnguinal herni erkeklerde, umblikal ve femoral herni kadýnlarda sýktý (p<0,001). Femoral hernide boðulma ve nekrozdan dolayý intestinal rezeksiyon diðer fýtýk türlerine göre anlamlý olarak yüksek saptandý (sýrasýyla, p<0,005 ve p<0,001). Morbidite ve mortalite üzerine; ileri yaþ (≥65 yaþ), ek hastalýk, strangülasyon, nekroz, yüksek AAD skoru (III, IV), semptomlarýn baþlama ve hastaneye baþvuru süresinin anlamlý etkisi bulundu. Genel anestezinin de morbidite için risk oluþturduðu görüldü (p<0,05).
SONUÇ
Boðulmuþ abdominal duvar hernileri yüksek morbidite ve mortalite oranýna sahip bir cerrahi problemdir. Bu yüzden herni saptandýðýnda elektif koþullarda ameliyat planlanmalýdýr.

Anahtar Kelimeler: Abdominal duvar hernisi, inkarserasyon; nekroz; strangülasyon.

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Incarcerated abdominal wall hernia surgery: relationship between risk factors and morbidity and mortality rates (a single center emergency surgery experience)

Erkan Özkan, Mehmet Kamil Yýldýz, Tuðrul Çakýr, Ender Dulundu, Cengiz Eriþ, Mehmet Mahir Fersahoðlu, Ümit Topaloðlu
Istanbul Haydarpasa Numune Training And Research Hospital, 5th General Surgery Clinic, Istanbul, Turkey

BACKGROUND
The aim of the present study was to investigate morbidity- and mortality-related risk factors in patients undergoing surgery due to incarcerated abdominal wall hernia.
METHODS
The patients were grouped according to the type of hernia (inguinal, umbilical, incisional, femoral), and these groups were evaluated in terms of risk factors affecting morbidity and mortality such as age, gender, American Society of Anesthesiologists (ASA) score, type of anesthesia, concomitant diseases, and the presences of intestinal strangulation and necrosis.
RESULTS
Inguinal hernia was frequent in males, whereas femoral hernia was frequent in females (p<0.001). The rate of intestinal resection due to strangulation and necrosis was found significantly higher among femoral hernias as compared to the other types of hernia (p<0.005 and p<0.001, respectively). Advanced age (≥65 years), concomitant disease, strangulation, necrosis, high ASA score (III-IV), time from the onset of symptoms, and time to hospital admission were found to have significant influences on morbidity and mortality. General anesthesia was found to be a risk factor for morbidity as well (p<0.05).
CONCLUSION
Incarcerated abdominal wall hernias are surgical problems with high morbidity and mortality rates. Therefore, surgery should be planned under elective conditions when hernia is detected.

Keywords: Abdominal wall hernia, incarceration; necrosis; strangulation.

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ATIF KOPYALA