Kasık Fıtıklarında Mesh Sabitleyiciler
Özet
Kasık fıtığı ameliyatlarında kullanılan gerilimsiz onarım teknikleri, prostetik materyallerin (mesh) kullanımı ile gelişmiştir. Bu materyallerin inguinal bölgede göç etmesini engellemek amacıyla sabitleme malzemeleri üretilmiştir. İdeal bir mesh sabitleyicinin morbiditeyi artırmaması, fizyolojik streslere dayanması, enfeksiyonlara dirençli olması ve doku uyumu sağlaması beklenir. Mesh sabitleyiciler arasında emilebilir veya metal raptiyeler, zımbalar, fibrin yapıştırıcılar, glue, Q halka, Mitek çıpa ve sütür materyalleri yer almaktadır. Her yöntemin kendine özgü avantaj ve dezavantajları vardır; örneğin sütür ve raptiye teknikleri ameliyat sonrası ağrıyı artırabilirken, doku yapıştırıcılarında bu ağrının daha az olduğu gözlenmiştir. Raptiye kullanımı bağırsak perforasyonu gibi riskler taşırken, sütür materyalleri nüks riskini azaltsa da operasyon süresini uzatmakta ve kanama riskini artırmaktadır. Sabitleyicilerin spermatik kord veya epigastrik damar yaralanmaları gibi morbiditeye yol açabilecek komplikasyon riski bulunmaktadır. Ameliyat sonrası hayat kalitesi, hastanın günlük aktivitelere dönüş hızı ve tedavi tatmini doğrudan kullanılan sabitleyicinin türü ile ilişkilidir. Sonuç olarak, mesh sabitleyicilerin maliyeti ve nüksü önlemedeki rolü düşünüldüğünde, kullanımının kesin gerekliliği konusunda daha fazla çalışmaya ihtiyaç duyulmaktadır.
Tension-free repair techniques used in inguinal hernia surgeries have evolved with the application of prosthetic materials known as mesh. Fixation devices have been developed to prevent these materials from migrating within the highly mobile inguinal region. An ideal mesh fixator is expected not to increase morbidity, to withstand physiological stresses, to resist infections, and to ensure tissue compatibility. Mesh fixators include absorbable or metal tacks, staples, fibrin sealants, glue, memory-ring (Q ring), Mitek anchor, and suture materials. Each method possesses distinct advantages and disadvantages; for instance, while suture and tack techniques may increase postoperative pain, this pain has been shown to be less severe with tissue adhesives. The use of tacks carries risks such as bowel perforation, whereas suture materials reduce the risk of recurrence but prolong operation time and increase bleeding risks. Fixation devices also pose a risk of complications that could lead to morbidity, such as injuries to the spermatic cord or epigastric vessels. Postoperative quality of life, the speed of returning to daily activities, and patient satisfaction are directly related to the type of fixator used. In conclusion, considering the cost of mesh fixators and their role in preventing recurrence, further studies are required to determine the exact necessity of their routine use.
Referanslar
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