Acil Kasık Fıtığı Cerrahisi
Özet
Rutin cerrahi pratiğinde sıkça uygulanan inguinal herni onarımı genellikle düşük riskli bir işlem olsa da, özellikle ileri yaştaki hastaların fıtıklarını geç fark etmesi acil kasık fıtığı cerrahisi oranlarını artırmaktadır. İnguinal herninin acil başvuruları, herni içeriğinin kendiliğinden redükte olamadığı inkarserasyon veya doku kan akımının bozulduğu strangülasyon nedeniyle gerçekleşir. Strangülasyon şüphesinde acil cerrahi mutlak endikasyon iken, bu durum dışlandığında sedo-analjezi altında manuel redüksiyon (taxis) denenerek operasyon elektif şartlara ertelenebilir; bu yaklaşım özellikle geriatrik hastalarda morbidite, mortalite ve hastanede kalış süresini azaltır. Teşhiste SIRS bulguları, kontrastlı bilgisayarlı tomografi, artmış laktat, CPK, D-dimer seviyeleri ve ultrasonografi (USG) önemli tanısal göstergelerdir. Ameliyatta teknik yaklaşım hastaya ve iskemik barsak rezeksiyonu ihtimaline göre seçilir. Temiz-kontamine cerrahi sahalarda polipropilen mesh kullanımı kontrendike olmamakla birlikte, perfore barsak içeren kirli yaralarda primer onarım önerilir. Yara sınıfına göre profilaktik antibiyoterapi planlanmalı; barsak rezeksiyonu durumunda 48 saatlik profilaksi, peritonitte ise efektif tedavi uygulanmalıdır.
Although inguinal hernia repair is a frequently performed procedure in routine surgical practice with generally low risk, the late awareness of hernias, especially in elderly patients, increases the rates of emergency groin hernia surgery. Emergency admissions for inguinal hernia occur due to incarceration, where the hernia content cannot be spontaneously reduced, or strangulation, which involves impaired blood flow to the tissue. While emergency surgery is an absolute indication when strangulation is suspected, if it is ruled out, manual reduction (taxis) under sedo-analgesia can be attempted to postpone the operation to elective conditions; this approach significantly reduces morbidity, mortality, and hospital stay, particularly in geriatric patients. In diagnosis, SIRS findings, contrast-enhanced computed tomography, elevated lactate, CPK, D-dimer levels, and ultrasonography (USG) serve as critical predictors. The surgical technique is chosen based on the patient's condition and the probability of ischemic bowel resection. Although the use of polypropylene mesh is not contraindicated in clean-contaminated surgical fields, primary repair is recommended for dirty wounds involving a perforated bowel. Prophylactic antibiotic therapy must be planned according to the wound class, with a 48-hour prophylaxis recommended in cases of bowel resection, and effective antimicrobial treatment administered for peritonitis.
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