İnkarsere Fıtıklar
Özet
Fıtıklar, karın duvarı fasyasındaki anormal açıklıklar olup sıklıkla ön duvar ve kasık bölgesinde yerleşir. İçeriğin karın boşluğuna geri itilemediği durumlar inkarsere fıtık, iskemi gelişen olgular ise strangüle fıtık olarak tanımlanır. Etiyolojisinde doğuştan gelen doku zayıflıkları, ameliyat kesileri, bağ dokusu hastalıkları ve KOAH gibi karın içi basıncı artıran faktörler rol oynar. Toplumun %5'inde görülen bu patolojide akut inkarserasyon sonrası geciken başvurular bağırsak rezeksiyonu ve mortalite riskini artırır. Tanıda valsalva manevrasıyla yapılan fizik muayene temel olmakla birlikte ultrason, bilgisayarlı tomografi ve laktat/d-dimer gibi laboratuvar belirteçlerinden yararlanılır. Tedavide, bağırsak dolaşım bozukluğu veya perforasyon şüphesi yoksa Trendelenburg pozisyonunda sedasyon altında manuel redüksiyon (taxis) denenebilir. Elektif şartlarda veya acil cerrahide fıtık onarımı cerrahın deneyimine göre açık ya da laparoskopik yöntemlerle gerçekleştirilir. Kontaminasyon riski olmayan durumlarda nüksü önlemek için sentetik yama kullanımı güvenliyken, aktif enfeksiyon veya perforasyon varlığında yamasız açık cerrahi teknikler (Bassini, Shouldice vb.) tercih edilir. Ameliyat sonrası dönemde komplikasyon takibi, nazogastrik dekompresyon ve 6-8 hafta ağır kaldırmaktan kaçınılması önerilir.
Hernias are abnormal openings in the abdominal wall fascia, commonly located in the anterior wall and groin regions. Incarcerated hernias occur when the content cannot be reduced back into the abdominal cavity, whereas cases developing ischemia are defined as strangulated hernias. Their etiology includes congenital tissue weakness, surgical incisions, connective tissue disorders, and factors increasing intra-abdominal pressure such as COPD. Affecting 5% of the population, delayed presentation after acute incarceration increases the risk of bowel resection and mortality. Although physical examination using the Valsalva maneuver is fundamental for diagnosis, ultrasound, computed tomography, and laboratory markers like lactate or d-dimer are also utilized. In treatment, if there is no suspicion of bowel ischemia or perforation, manual reduction (taxis) can be attempted under sedation in the Trendelenburg position. Depending on the surgeon's experience, hernia repair is performed via open or laparoscopic techniques in elective or emergency settings. While synthetic mesh placement is safe to prevent recurrence in non-contaminated cases, non-mesh open surgical techniques (such as Bassini or Shouldice) are preferred in the presence of active infection or perforation. Postoperative management requires complication monitoring, nasogastric decompression, and avoiding heavy lifting for 6-8 weeks.
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