Nüks İnguinal Herniler
Özet
Dünyada en yaygın cerrahi operasyonlardan olan inguinal herni onarımında, gelişmiş teknik ve mesh kullanımına rağmen nüks oranı %12-13 civarındadır. "World Guidelines for Groin Hernia Management", nüksleri %60 azalttığı için meshsiz onarımı önermemektedir. Etiyolojisi multifaktöriyel olup hastaya ve cerrahiye ait faktörler rol oynar. Kadın cinsiyette gözden kaçan femoral herniler, VKİ'nin 30'dan büyük olması, kord lipomunun atlanması, medial yerleşim, diyabet, KOAH ve sigara kullanımı hastaya bağlı önemli nüks nedenleridir. Cerrahi tarafta ise gergin yama, cerrahın vaka hacminin yıllık 25'ten az olması, merkezin vaka sayısının 50'den az olması ve operasyon süresinin 36 dakikadan kısa sürmesi nüks riskini artırır. Tanı genellikle anamnez ve fizik muayene ile konur; şüpheli durumlarda ultrason, BT veya MRG gibi görüntüleme yöntemlerine başvurulur. Tedavide cerrahi yaklaşım seçimi kritik öneme sahiptir. İkinci nüks riskini azaltmak ve komplikasyonları önlemek amacıyla temiz plandan çalışmak gerekir; bu doğrultuda ilk ameliyat anterior (açık) yöntemle yapılmışsa posterior laparoskopik yaklaşım, başarısız preperitoneal onarımlarda ise açık anterior yöntem tercih edilmelidir.
In inguinal hernia repair, which is one of the most common surgical operations worldwide, the recurrence rate is around 12-13% despite advanced techniques and mesh utilization. The "World Guidelines for Groin Hernia Management" does not recommend non-mesh repair since mesh usage reduces recurrences by 60%. Its etiology is multifactorial, involving both patient-related and surgical factors. Overlooked femoral hernias in females, a BMI greater than 30, missed cord lipoma, medial location, diabetes, COPD, and smoking are significant patient-related recurrence reasons. On the surgical side, a tense mesh, a surgeon's annual volume below 25 cases, a center's volume below 50 cases, and an operative time shorter than 36 minutes increase the risk of recurrence. Diagnosis is generally established via history and physical examination; imaging methods like ultrasound, CT, or MRI are utilized in suspicious cases. The choice of surgical approach is of critical importance in treatment. To reduce the risk of a secondary recurrence and prevent complications, it is necessary to work through a clean plane; accordingly, if the primary operation was performed via an anterior (open) method, a posterior laparoscopic approach should be preferred, whereas failed preperitoneal repairs should be approached with the open anterior method.
Referanslar
Brunicardi F Charles, et al. Schwartz's Principles Of Surgery,11th Edition. McGraw-Hill Company; Newyork 2019
Courtney M. Townsend, Sabiston’s Textbook of Surgery 21th edition. Elsevier; Canada 2022
HerniaSurge Group. International guidelines for groin hernia management. Hernia. 2018 Feb;22(1):1-165. doi: 10.1007/s10029-017-1668-x. Epub 2018 Jan 12. PMID: 29330835; PMCID: PMC5809582.
Burcharth J. The epidemiology and risk factors for recurrence after inguinal hernia surgery. Dan Med J. 2014 May;61(5):B4846. PMID: 24814748.
Leibl BJ, Schmedt CG, Kraft K, Kraft B, Bittner R. Laparoscopic transperitoneal hernia repair of incarcerated hernias: Is it feasible? Results of a prospective study. Surg Endosc. 2001 Oct;15(10):1179-83. doi: 10.1007/s004640090073. Epub 2001 Aug 16. PMID: 11727097.
Tue Sorensen L, Friis E, Jorgensen T, et al. Smoking Is a Risk Factor for Recurrence of Groin Hernia. World J Surg 26, 397–400 (2002). https://doi.org/10.1007/s00268-001-0238-6
Köckerling F, Bittner R, Jacob DA, Seidelmann L, Keller T, Adolf D, Kraft B, Kuthe A. TEP versus TAPP: comparison of the perioperative outcome in 17,587 patients with a primary unilateral inguinal hernia. Surg Endosc. 2015 Dec;29(12):3750-60. doi: 10.1007/s00464-015-4150-9. Epub 2015 Mar 25. PMID: 25805239; PMCID: PMC4648956.
Andresen K, Friis-Andersen H, Rosenberg J. Laparoscopic Repair of Primary Inguinal Hernia Performed in Public Hospitals or Low-Volume Centers Have Increased Risk of Reoperation for Recurrence. Surgical Innovation. 2016;23(2):142-147. doi:10.1177/1553350615596636
Köckerling F, Bittner R, Kraft B, Hukauf M, Kuthe A, Schug-Pass C. Does surgeon volume matter in the outcome of endoscopic inguinal hernia repair? Surg Endosc. 2017 Feb;31(2):573-585. doi: 10.1007/s00464-016-5001-z. Epub 2016 Jun 22. PMID: 27334968; PMCID: PMC5266765.
van der Linden W, Warg A, Nordin P. National register study of operating time and outcome in hernia repair. Arch Surg. 2011 Oct;146(10):1198-203. doi: 10.1001/archsurg.2011.268. PMID: 22006880.
Sanders DL, Waydia S. A systematic review of randomised control trials assessing mesh fixation in open inguinal hernia repair. Hernia. 2014 Apr;18(2):165-76. doi: 10.1007/s10029-013-1093-8. Epub 2013 May 7. PMID: 23649403.
Kaul A, Hutfless S, Le H, Hamed SA, Tymitz K, Nguyen H, Marohn MR. Staple versus fibrin glue fixation in laparoscopic total extraperitoneal repair of inguinal hernia: a systematic review and meta-analysis. Surg Endosc. 2012 May;26(5):1269-78. doi: 10.1007/s00464-011-2025-2. Epub 2012 Feb 21. PMID: 22350225.
Bouras G, Burns EM, Howell AM, Bottle A, Athanasiou T, Darzi A. Linked hospital and primary care database analysis of the impact of short-term complications on recurrence in laparoscopic inguinal hernia repair. Hernia. 2017 Apr;21(2):191-198. doi: 10.1007/s10029-017-1575-1. Epub 2017 Jan 27. PMID: 28130603.
Shakil A, Aparicio K, Barta E, Munez K. Inguinal Hernias: Diagnosis and Management. Am Fam Physician. 2020 Oct 15;102(8):487-492. PMID: 33064426.
Berndsen MR, Gudbjartsson T, Berndsen FH. [Inguinal hernia - review]. Laeknabladid. 2019 Sep;105(9):385-391. Icelandic. doi: 10.17992/lbl.2019.09.247. PMID: 31482863.
Bradley M, Morgan D, Pentlow B, Roe A. The groin hernia - an ultrasound diagnosis? Ann R Coll Surg Engl. 2003 May;85(3):178-80. doi: 10.1308/003588403321661334. PMID: 12831490; PMCID: PMC1964363.
Robinson A, Light D, Kasim A, Nice C. A systematic review and meta-analysis of the role of radiology in the diagnosis of occult inguinal hernia. Surg Endosc. 2013 Jan;27(1):11-8. doi: 10.1007/s00464-012-2412-3. Epub 2012 Jun 26. PMID: 22733195.
Markos V, Brown EF. CT herniography in the diagnosis of occult groin hernias. Clin Radiol. 2005 Feb;60(2):251-6. doi: 10.1016/j.crad.2004.02.013. PMID: 15664580.
van den Berg JC, de Valois JC, Go PM, Rosenbusch G. Detection of groin hernia with physical examination, ultrasound, and MRI compared with laparoscopic findings. Invest Radiol. 1999 Dec;34(12):739-43. doi: 10.1097/00004424-199912000-00002. PMID: 10587869.
Kokotovic D, Bisgaard T, Helgstrand F. Long-term Recurrence and Complications Associated With Elective Incisional Hernia Repair. JAMA. 2016 Oct 18;316(15):1575-1582. doi: 10.1001/jama.2016.15217. PMID: 27750295.
Burger JW, Luijendijk RW, Hop WC, Halm JA, Verdaasdonk EG, Jeekel J. Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg. 2004 Oct;240(4):578-83; discussion 583-5. doi: 10.1097/01.sla.0000141193.08524.e7. PMID: 15383785; PMCID: PMC1356459.
Karthikesalingam A, Markar SR, Holt PJ, Praseedom RK. Meta-analysis of randomized controlled trials comparing laparoscopic with open mesh repair of recurrent inguinal hernia. Br J Surg. 2010 Jan;97(1):4-11. doi: 10.1002/bjs.6902. PMID: 20013926.
