Postoperatif Hasta Yönetimi
Özet
Kasık fıtığı onarımı sonrası postoperatif yönetim, hastaların ameliyat öncesi fonksiyonlarına hızla dönmesini ve erken aktiviteyi amaçlar. Ameliyat sonrası anestezi sonrası bakım ünitesine alınan hastalarda ağrı, bulantı ve yan etkilerin en aza indirilmesi hedeflenir. Hafif ve orta şiddetteki postoperatif ağrılarda, opioidlerin yan etkilerinden kaçınmak için nonsteroid antiinflamatuar ilaçlar (NSAID) ve asetaminofen kullanımı ile buz uygulaması önerilir. Postoperatif bulantı ve kusma riskini azaltmak için opioidlerden kaçınılması ve antiemetik ilaçların kullanımı tercih edilir. İdrar retansiyonu ve hipervolemiyi önlemek adına perioperatif sıvı alımı genellikle 1000 ml'nin altında sınırlandırılmalıdır. Spontan işeyebilen hastaların taburcu edilmesi standart bir yaklaşım olup, işeme başarısızlığı durumunda kateterizasyon uygulanır. Taburculuk için stabil hayati bulgular ve kontrol altına alınmış ağrı düzeyi aranır. İyileşme sürecinde erken mobilizasyon; pulmoner performansı artırır ve ileus riskini azaltır. Güncel kılavuzlar, ameliyat sonrası rutin fiziksel kısıtlamaların rekürrense etkisinin olmadığını göstererek hastaların tolere edebildikleri andan itibaren günlük aktivitelerine dönmelerini destekler; ancak spor salonunda ağırlık çalışanlara 4-6 hafta boyunca 25 kg üzerini kaldırmamaları önerilir. Ayrıca, operasyon öncesi ara verilen antikoagülan ve antiagregan ilaçlara kanama riski durumuna göre 24 ila 72 saat sonra yeniden başlanabilir. Hastalar yara bakımı ve seroma takibi için 2-3 hafta sonra kontrole çağrılır.
Postoperative management after inguinal hernia repair aims to quickly restore patients to their preoperative functions and encourage early activity. In patients taken to the postanesthesia care unit, the goal is to minimize pain, nausea, and side effects. For mild to moderate postoperative pain, the use of nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and ice packs is recommended to avoid opioid-related side effects. To reduce the risk of postoperative nausea and vomiting, avoiding opioids and utilizing antiemetic medications are preferred. To prevent urinary retention and hypervolemia, perioperative fluid intake should generally be limited to under 1000 ml. Discharging patients who can void spontaneously is standard practice, and catheterization is applied in case of voiding failure. Discharge criteria require stable vital signs and controlled pain levels. Early mobilization improves pulmonary performance and reduces the risk of postoperative ileus. Current guidelines show that routine physical restrictions have no impact on recurrence, supporting a return to daily activities as soon as tolerated; however, those lifting weights at the gym are advised not to exceed 25 kg for 4-6 weeks. Additionally, anticoagulants and antiaggregants paused before surgery can be restarted 24 to 72 hours postoperatively depending on bleeding risk. Patients are scheduled for a follow-up visit in 2-3 weeks for wound care and seroma monitoring.
Referanslar
Siegal SR, Orenstein SB. Postoperative Management. In: Surgical Principles in Inguinal Hernia Repair [Internet]. Cham: Springer International Publishing; 2018. p. 91–8. Available from: http://link.springer.com/10.1007/978-3-319-92892-0_13
Millard JL, Moraney R, Childs JC, Ewing JA, Carbonell AM, Cobb WS, et al. Opioid Use After Inguinal and Ventral Hernia Repair. The American surgeon [Internet]. 2020 Aug 1 [cited 2022 Mar 7];86(8):965–70. Available from: https://pubmed.ncbi.nlm.nih.gov/32779472/
Mylonas KS, Reinhorn M, Ott LR, Westfal ML, Masiakos PT. Patient-reported opioid analgesic requirements after elective inguinal hernia repair: A call for procedure-specific opioid-administration strategies. Surgery [Internet]. 2017 Nov 1 [cited 2022 Mar 7];162(5):1095–100. Available from: https://pubmed.ncbi.nlm.nih.gov/28778580/
Mixter CG, Meeker LD, Gavin TJ. Preemptive pain control in patients having laparoscopic hernia repair: a comparison of ketorolac and ibuprofen. Archives of surgery (Chicago, Ill : 1960) [Internet]. 1998 Apr [cited 2022 Mar 7];133(4):432–7. Available from: https://pubmed.ncbi.nlm.nih.gov/9565125/
Gobble RM, Hoang HLT, Kachniarz B, Orgill DP. Ketorolac does not increase perioperative bleeding: a meta-analysis of randomized controlled trials. Plastic and reconstructive surgery [Internet]. 2014 Mar [cited 2022 Mar 7];133(3):741–55. Available from: https://pubmed.ncbi.nlm.nih.gov/24572864/
Tran H. Endorsement of the HerniaSurge guidelines by the Australasian Hernia Society. Vol. 22, Hernia. Springer-Verlag France; 2018. p. 177.
Apfel CC, Korttila K, Abdalla M, Kerger H, Turan A, Vedder I, et al. A Factorial Trial of Six Interventions for the Prevention of Postoperative Nausea and Vomiting [Internet]. Vol. 350, n engl j med. 2004. Available from: www.nejm.org
Koch CA, Grinberg GG, Farley DR. Incidence and risk factors for urinary retention after endoscopic hernia repair. American journal of surgery [Internet]. 2006 Mar [cited 2022 Mar 10];191(3):381–5. Available from: https://pubmed.ncbi.nlm.nih.gov/16490551/
Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia : the journal of hernias and abdominal wall surgery [Internet]. 2009 [cited 2022 Mar 10];13(4):343–403. Available from: https://pubmed.ncbi.nlm.nih.gov/19636493/
Petros JG, Rimm EB, Robillard RJ, Argy O. Factors influencing postoperative urinary retention in patients undergoing elective inguinal herniorrhaphy. American journal of surgery [Internet]. 1991 [cited 2022 Mar 10];161(4):431–3. Available from: https://pubmed.ncbi.nlm.nih.gov/2035761/
Bay-Nielsen M, Thomsen H, Heidemann Andersen F, Bendix JH, Sørensen OK, Skovgaard N, et al. Convalescence after inguinal herniorrhaphy. The British journal of surgery [Internet]. 2004 Mar [cited 2022 Mar 11];91(3):362–7. Available from: https://pubmed.ncbi.nlm.nih.gov/14991640/
Schrenk P, Woisetschläger R, Rieger R, Wayand W. Prospective randomized trial comparing postoperative pain and return to physical activity after transabdominal preperitoneal, total preperitoneal or Shouldice technique for inguinal hernia repair. The British journal of surgery [Internet]. 1996 [cited 2022 Mar 11];83(11):1563–6. Available from: https://pubmed.ncbi.nlm.nih.gov/9014675/
Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia : the journal of hernias and abdominal wall surgery [Internet]. 2009 [cited 2022 Mar 11];13(4):343–403. Available from: https://pubmed.ncbi.nlm.nih.gov/19636493/
Bittner R, Montgomery MA, Arregui E, Bansal V, Bingener J, Bisgaard T, et al. Update of guidelines on laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia (International Endohernia Society). Surgical endoscopy [Internet]. 2015 Jan 14 [cited 2022 Mar 11];29(2):289–321. Available from: https://pubmed.ncbi.nlm.nih.gov/25398194/
