İnsizyonel Herni Tanı ve Tedavi
Özet
İnsizyonel herniler, abdominal cerrahi sonrası fasyal kapanmanın bozulmasıyla gelişen, yaşam kalitesini bozan ve nüks oranı yüksek komplikasyonlardır. Orta hat insizyonlarında ve vertikal kesilerde daha sık görülen bu durum, morbidite ve sosyoekonomik açıdan ciddi bir problem teşkil eder. Oluşumunda sigara, yaşlılık, obezite gibi hastaya bağlı faktörlerin yanı sıra cerrahi alan enfeksiyonları ve suboptimal dikiş teknikleri gibi teknik faktörler de rol oynar. Tanı genellikle fizik muayene ve ultrasonografi ile konurken, kompleks vakalarda bilgisayarlı tomografi tercih edilir; rektus diastazı ve hematom gibi durumlarla ayırıcı tanı yapılmalıdır. Tedavi yaklaşımı, semptomların şiddetine göre nonoperatif takip veya cerrahi onarım olarak belirlenir. Akut strangüle ve inkarsere herniler acil müdahale gerektirirken, elektif cerrahilerde yüksek obezite, kontrolsüz diyabet ve sigara kullanımı önemli rölatif kontrendikasyonlardır. Onarımda laparoskopik ve açık mesh (onlay, inlay, sublay) teknikleri kullanılır. Laparoskopik yöntem daha az enfeksiyon riski ve kısa hastanede kalış süresi sunarken; açık onarımda sublay tekniği, onlay ve inlay yöntemlerine kıyasla daha düşük nüks ve seroma oranlarına sahiptir. Kronik ağrı ve gebelik gibi özel durumlarda cerrahi kararı hastaya göre bireyselleştirilir ve en önemli prognostik faktör cerrahın tecrübesidir.
Incisional hernias are complications with high recurrence rates that develop due to the disruption of fascial closure after abdominal surgery, impairing the patient's quality of life. More common in midline incisions and vertical cuts, this condition poses a significant problem in terms of morbidity and socioeconomic costs. Its development involves patient-related factors such as smoking, advanced age, and obesity, as well as technical factors like surgical site infections and suboptimal suturing techniques. While diagnosis is generally established through physical examination and ultrasonography, computed tomography is preferred in complex cases, requiring a differential diagnosis from conditions like rectus diastasis and hematoma. The treatment approach is determined as nonoperative follow-up or surgical repair depending on the severity of symptoms. Acute strangulated and incarcerated hernias require emergency intervention, whereas high obesity, uncontrolled diabetes, and smoking are significant relative contraindications in elective surgery. Laparoscopic and open mesh (onlay, inlay, sublay) techniques are used for repair. The laparoscopic method offers a lower risk of infection and shorter hospital stays; in open repair, the sublay technique provides lower recurrence and seroma rates compared to the onlay and inlay methods. In special circumstances such as chronic pain and pregnancy, the surgical decision is individualized, and the surgeon's experience remains the most critical prognostic factor.
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