Avtor/Urednik		Rakovec, Slavko; Mlakar, Boštjan
Naslov		Izkušnje z odprtimi nenapetostnimi postopki oskrbe dimeljskih kil
Prevedeni naslov		Experience with the open tension-free hernia repair
Tip		članek
Vir		Zdrav Vestn
Vol. in št.		Letnik 71, št. 3
Leto izdaje		2002
Obseg		str. 167-72
Jezik		slo
Abstrakt		Background. All old techniques of herniorrhaphy involve approximation of tissues under tension, which accounts for their unreliability. Therefore the recovery time is long and the recurrence rate unacceptably high. The new methods using a mesh patch of polypropylene allow for a tension-free repair, which is much more reliable. So they are associated with a shorter recovery time and carry a low probability of recurrence. The tension-free repair can be accomplished in an open manner, by placing the mesh through an open incision, or by the endoscopic technique, which involves placing the mesh from within by laparoscopic instruments. The open tension-free procedures can be performed with the use of stitches (according to Lichtenstein) or without them (sutureless techniques). Stitching the mesh may cause problems due to maldistribution of tension between the mesh and the patients tissues, the occurrence of neuralgija or the development of inflammatory granuloma. Therefore sutureless procedures are increasingly performed. They usually require, besides the use of a mesh patch, also the use of a dart plug made of the same material. Methods. The open tension-free methods of hernia repair have been used at our Department since 1994. The first 77 operations were performed by Lichtenstein technique. The mean postoperative hospital stay was 3.4 days and the mean work restriction period was 3 weeks. In the middle of the year 1995, we shifted to suturless technique. By the end of the year 2000, we had performed 768 operations. The average postoperative hospital stay was 1.2 days and the average recovery time was 10 days. Results. In the first group of 77 hernia repairs performed by the Lichtenstein procedure serious complications were noted in six patients: bleeding in one, long-lasting neuralgia in two, and purulent granuloma, appearing long after discharge from the hospital, in three. There were no recurrences. (Abstract truncated at 2000 characters).
Izvleček		Izhodišča. Nasilno združevanje tkiv, ki se mu pri klasičnih postopkih ne moremo izogniti, je vzrok za napetost hernioplastik in za njihovo nezanesljivost. Zato je potreben dolg pooperacijski počitek, vendar so kljub temu recidivi pogostni. Šele uporaba mrežne krpe iz polipropilena omogoča postopke, pri katerih ne nastane napetost in so povezave zanesljive, kar dovoljuje hitro aktivacijo ter znatno zmanjša verjetnost recidivov. Nenapetostni postopki so odprti, če vstavimo krpo skozi zunanji zarez, in laparoskopski, če jo vstavimo od znotraj z endoskopskimi instrumenti. Odprto nenapetostno hernioplastiko lahko naredimo s pritrditvijo mreže s šivi (po Lichtensteinu) ali tudi brez uporabe šivov (brezšivni postopki). Ker pritrditev mreže lahko povzroči nekaj težav, saj ovira prilagajanje njenega položaja bolnikovim tkivom ali je lahko vzrok za nevralgije in vnetne granulome, se čedalje bolj uveljavljajo brezšivni postopki. Pri teh je treba poleg mrežne krpe uporabiti še posebej oblikovan zamašek iz enakega materiala. Metode. Pri nas smo leta 1994 začeli operirati po Lichtensteinovem postopku. Naredili smo 77 hernioplastik. Povprečna pooperacijska hospitalizacija je trajala 3,4 dni, povprečni bolniški stalež pa 3 tedne. Od sredine leta 1995 operiramo po brezšivnem postopku in smo do konca leta 2000 naredili 768 hernioplastik. Povprečna pooperacijska hospitalizacija je trajala 2,1 dan, povprečni bolniški stalež pa 10 dni. Rezultati. Pri prvi skupini 77 hernioplastik po Lichtensteinovem postopku so se resnejši zapleti pojavili pri šestih operirancih: pri enem krvavitev, pri dveh dolgotrajne nevralgije in pri treh, pozno po odpustu iz bolnišnice, zagnojeni granulomi. Recidivov ni bilo. Pri drugi skupini 768 hernioplastik po brezšivnem postopku je bilo malo zapletov. V 1,5% se je pojavil hematom, parastezije so se pojavile v 0,9%, do površinske okužbe je prišlo v 1,8%, absces globlje v podkožju pa se je razvil le v 0,3%. (Izvleček prekinjen pri 2000 znakih).
Deskriptorji		HERNIA, INGUINAL SURGICAL MESH POSTOPERATIVE COMPLICATIONS TREATMENT OUTCOME