Factors affecting the time of surgery in emergent groin hernia cases Acil Kasık Fıtığı Olgularında cerrahi süresini Etkileyen Faktörler
Salih Tosun, Metin Leblebici, Oktay Yener, Muhammet ali Aydemir, Özgür Ekinci, Orhan Alimoglu
Aim: To determine the safety principles of hernia surgery for patients who underwent emergent groin hernia surgery by evaluating risk factors, diagnostic methods, the time up to the operation and surgical techniques. Methods: In this study, the patients operated for groin hernia repair between the years 2017 and 2019 were evaluated. The demographic characteristics, physical examination findings, co-morbidities, radiologic assesments, operation notes, the time of arrival to the hospital and the operation time of patients who needed immediate surgical intervention were analyzed from the data system of the hospital. The patients were classified as group 1 for the ones with radiologic assesment before the operation and group 2 for the ones whose decision of operation was taken after physical examination only. Results: The risk evaluation of patients operated for incarceration or strangulation revealed the observation that in comparison with elective surgery, women (elective 9%, emergent 31%) and femoral hernias (elective 1.3%, emergent 21.4%) are much more in emergent surgery group. The diagnosis of patients was based on physical examination findings and radiologic methods were applied for 85.7% of the patients preoperatively. Radiologic assessments prolonged the time for operation and increased the morbidity and intestinal resection. For the evaluation of hernia sac, hernioscopy at %7 of patients and groin exploration from the incision at 93% of patients provided us the appropriate diagnosis. Conclusions: For emergent hernia surgery, the operation should be performed immediately after physical examination without considering strangulation or incarceration. Apart from suspicious conditions such as obesity and recurrent cases, using radiologic methods for diagnosis may lead to delays and cause morbidities and mortalities. In case of spontaneous reduction; incisional exploration, hernioscopy, laparoscopy or laparotomy should be performed if there is any suspicion on intestinal viability.