İnkarsere/Strangule İnguinal Hernilerde Cerrahi Teknik Tapp vs Açık Herni Onarımı
Özet
İnguinal herni, en sık görülen karın duvarı fıtığı olup, elektif onarımlarda laparoskopik tekniklerin açık cerrahiye üstünlüğü bilinmektedir. Ancak, acil durumlarda laparoskopik cerrahinin yeri net değildir. Asemptomatik hastaların önemli bir kısmı zamanla semptomatik hale gelerek acil servislere inkarsere veya strangule herni tablosuyla başvurmaktadır. Bu durumlarda tek tedavi yöntemi hızlı cerrahi müdahaledir. Transabdominal preperitoneal (TAPP) tekniği, acil inguinal herni onarımlarında hem yetişkinlerde hem de çocuklarda güvenle uygulanabilen bir yöntem olarak öne çıkmaktadır. TAPP tekniğinin en büyük avantajı, sıkışan viseral dokunun ve bağırsakların canlılığının, peristaltizminin ve perforasyon durumunun aynı prosedür içinde doğrudan değerlendirilmesine olanak tanımasıdır. Ayrıca kontralateral herni gibi ek patolojilerin tanısını kolaylaştırır, daha az ağrı, kısa hastanede yatış ve erken iyileşme gibi laparoskopinin standart avantajlarını sunar. Buna karşın, öğrenme eğrisine bağlı uzun ameliyat süresi, genel anestezi gerekliliği ve bağırsak dilatasyonu durumunda iatrojenik yaralanma riskleri gibi dezavantajları bulunmaktadır. Bağırsak perforasyonu varlığında ise yama (mesh) kullanılmaması ve kontralateral tamirin ertelenmesi önerilmektedir.
Inguinal hernia is the most common type of abdominal wall hernia, and the superiority of laparoscopic techniques over open surgery in elective repairs is well known. However, the role of laparoscopic surgery in emergency settings remains unclear. A significant portion of asymptomatic patients become symptomatic over time and present to emergency departments with incarcerated or strangulated hernia formations. In these cases, the only treatment method is prompt surgical intervention. The transabdominal preperitoneal (TAPP) technique stands out as a method that can be safely performed in emergency inguinal hernia repairs in both adults and children. The greatest advantage of the TAPP technique is that it allows for the direct evaluation of the viability, peristalsis, and perforation status of the incarcerated visceral tissue and intestines within the same procedure. Additionally, it facilitates the diagnosis of additional pathologies such as contralateral hernia, and offers standard advantages of laparoscopy including less pain, shorter hospital stay, and early recovery time. On the other hand, it has disadvantages such as a longer operation time depending on the learning curve, the necessity of general anesthesia, and the risks of iatrogenic injury in case of intestinal dilatation. In the presence of intestinal perforation, it is recommended to avoid using a mesh and to postpone contralateral repair.
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