Katmanlara ayırma tekniği ile onarılmış dev ventral hernilerin retrospektif klinik analizi
Retrospective clinical analysis of giant ventral hernias repaired with components separation technique
Yazar: TUĞRUL KESİCİOĞLU
Danışman: PROF. DR. KENAN ERZURUMLU
Ondokuz Mayıs Üniversitesi / Tıp Fakültesi / Genel Cerrahi Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2012
Konu: Genel Cerrahi = General Surgery
Dizin: Cerrahi = Surgery ; Cerrahi tedavi = Surgical treatment ; Cerrahi-abdominal = Surgery-abdominal ; Herni-ventral = Hernia-ventral ; Herniler = Hernia ; Retrospektif çalışmalar = Retrospective studies

Özet:
ÖZETGiRiSBiiyiik orta hat abdominal hernilerin onanml zordur ve bu onanmda hangi tekniginkullanilacag1l1a karar vermek ie,:in gene I kabul gormii~ bir veri bulunmamaktadlr.MATERiAL VE METODNisan 2004 - Subat 2012 Yillan aras1l1da dey abdominal fllIk tanlsl ile takip edilen 40 olgue,:ah~maya dal1il edildi. iki rektus kas1l1111 ortas1l1da bulunan, fltlk hacmi 1,5 litreden ve fitlkdefektinin yatay veya dikey boyutundan en az biri 15 em' den biiyiik olan Katrnanlara AynmaTeknigi ile ameliyat edilen olgular e,:ah~maya dahil edildi. Bu teknik ile tamir edilen deyabdominal hemilerin bulgularlI1lI1 ve sonue,:lannlI1 retrospektifklinik analizinin yapilmaslBULGULARPostoperatif ilk 3 ayhk periyot diliminde olu~an komplikasyonlar, "postoperatif erkenkomplikasyonlar", 3 ayhk periyot diliminden soma geli~en komplikasyonlar "postoperatif gee,:komplikasyonlar" olarak adlandmldl.. KAT uygulanan olgularda postoperatif erkenkomplikasyonlar; seroma, yara yeri yeri enfeksiyonu, nekroz, pnomoni, peritonit olarakslmflandmldl. Seroma goriilmesi 12 vaka ile en sikh. Yara yeri enfeksiyonu 8 hastada, nekroz4 hastada, pnomoni I hast ada, peritonit I hastada goriildu. Bu hastalar mortal seyretti. Postopkomplikasyonlar; kronik siniis drenajl ve ae,:lk yara pansumaJ11 olarak slmflandmldl. 4 hastadakronik sinUs drenajl ve ae,:lk yara pansumanl izlendi. <;:ah~ma serimizde top lam niiks olanhasta saYlmlz 2 olarak tespit edildi.Curl-up skorlamasl J. Vanda taraflI1dan tanlmlanan, basit bir abdominal duvar fonksiyontestidir. <;:ah~mamlz boyunca tiim hastalara preoperatif ve postoperatif 3. ayda kann on duvankaslannlI1 hareketliligi degerlendirilmesi ic,:in kullamlan curl-up skorlamasl uygulandl.Olgulann preop ortanca degeri 2,07( 1-4), postoperatif ortanca degeri 4.00 (0-5)'a kadaryiikse lmi~dir. VakalarlI1 bir tanesi haric,: tiimiinde kas hareketliliginde diizelme meydanagelmi~tir. Preoperatif ve post opreratif bu farkhhk Wilcoxon testine gore istatistiksel olarakanlamlI .bulundu. (p

Abstract:
ABSTRACTRETROSPECTIVE CLINICAL ANALYSIS OF GIANT VENTRAL HERNIAS REPAIREDWITH COMPONENTS SEPARATION TECHNIQUEINTRODUCTIONRepair of huge midline ventral hernias' are problematic and there is no general consensus onwhich technique should be used in this type of hernia repair.MATERIAL AND METHODForty cases followed-up with the diagnosis of huge abdominal hernia between April 2004-February 2012 were included in the study. Cases with a hernia volume between the the tworectus muscles of more than 2 liters and at least one of the vertical and horizontal dimensionslarger than 15 cm, operated on using the Components Separation Technique were includedin the study. A retrospective analysis of these cases of huge abdominal hernias repaired usingthis technique and their results were aimed.FINDINGSComplications occurred in the period of first 3 months were named "postoperative earlycomplications", while complications developing after the first three months' period were Postoperative patient satisfaction was evaluated' as well. A scale between I and 10 wasformed. An independent team contacted the patients and asked them to score theirpreoperative and postoperative status with a scale between 1 and 10. Two patients withmortality were excluded from the statistical analysis. Median value of satisfaction wascalculated as 8,8 (range 6-10).DISCUSSIONThese results demonstrate that components separation technique is well tolerated by thepatients. Components separation technique is accepted as a good alternative method in therepair of huge abdominal hernias. Abdominal wall functions of the patients demonstrated asignificant degree of improvemeni after the operation. Repair of the defects by thecomponents separation technique in dynamic reconstruction of large anterior abdominal walldefects with difficult repair is a successful method in the restoration of anterior abdominalwall function, well tolerated by the patients, with a decreased rate of complications withexpenence.KEYWORDSComponents separation technique, ventral hernia, abdominal hernia, Curl-up scoring, mashnamed as "postoperative late complications". Postoperative early complications in casestreated with CST technique were classified as seroma, wound infection, necrosis, pneumonia,and peritonitis. Seroma was the most commonly seen complication with 12 cases. Woundinfection was seen in 8 patients while necrosis in 4 patients and pneumonia and peritonitis in1 cases, each. These cases resulted in mortality. Postoperative complications were classifiedas chronic sinus drainage and open wound dressing. Four patients had chronic sinus drainageand open wound dressing. Total number of cases with recurrence was 2 in this series.Curl-up scoring is a simple abdominal wall function test defined by J. Vanda. During thisstudy, curl-up scoring was used in all patients preoperatively and in the postoperative 3rdmonth to evaluate the mobility of anterior abdominal wall muscles. Preoperative median valueof the cases was 2,07 (range: 1-4) and this value was increased to 4.00 (range: 0-5) at thepostoperative 3rd month measurement. Improvement in the muscle motility was observed inall but one case. This difference in the preoperative and postoperative Curl-up scores wasfound to be statistically significant by Wilcoxon test (p