İnguinal Herni ve Acil Servis Başvurusu
Özet
İnguinal herni, acil servis başvurularında sık karşılaşılan cerrahi patolojilerden biri olup kasık bölgesinde şişlik ve ağrı ile karakterizedir. İnguinal herniler direkt, indirekt ve femoral olmak üzere sınıflandırılmakta olup indirekt inguinal herni en sık görülen tiptir. İnkarsere ve strangüle herniler, acil cerrahi müdahale gerektiren yaşamı tehdit eden komplikasyonlardır. İnkarsere hernide bağırsak segmentinin herni kesesine hapsolması sonucu mekanik bağırsak tıkanıklığı gelişirken, strangülasyonda vasküler kompromise bağlı iskemi ve nekroz riski ortaya çıkmaktadır. Bu bölümde inguinal hernilerin epidemiyolojisi, klinik bulguları, tanısal yaklaşımları ve güncel kılavuzlar eşliğinde tedavi stratejileri ele alınmıştır. Fizik muayene ile tanı konulamayan olgularda ultrasonografi (USG) ve bilgisayarlı tomografi (BT) yararlı tanısal araçlardır. İnkarsere hernilerde manuel redüksiyon girişimi, başarısız olması halinde acil cerrahi onarım ve strangüle hernilerde bağırsak rezeksiyonu gerekliliğinin değerlendirilmesi tedavi yaklaşımlarının temel bileşenlerini oluşturmaktadır.
Inguinal hernia is one of the most commonly encountered surgical pathologies in the emergency department, characterized by swelling and pain in the groin region. Inguinal hernias are classified as direct, indirect, and femoral types, with indirect inguinal hernia being the most common. Incarcerated and strangulated hernias are life-threatening complications requiring emergent surgical intervention. In incarcerated hernias, entrapment of the bowel segment within the hernia sac leads to mechanical bowel obstruction, while strangulation carries the risk of ischemia and necrosis due to vascular compromise. This chapter reviews the epidemiology, clinical features, diagnostic approaches, and current guideline-based treatment strategies for inguinal hernias. Ultrasonography and computed tomography are useful diagnostic tools when physical examination is inconclusive. Manual reduction in incarcerated hernias, emergent surgical repair upon failure, and evaluation of the need for bowel resection in strangulated hernias constitute the main components of the treatment approaches.
Referanslar
HerniaSurge Group. International guidelines for groin hernia management. Hernia. 2018;22(1):1-165.
Fitzgibbons RJ Jr, Forse RA. Clinical practice. Groin hernias in adults. N Engl J Med. 2015;372(8):756-63.
Öberg S, Andresen K, Rosenberg J. Etiology of Inguinal Hernias: A Comprehensive Review. Front Surg. 2017;4:52.
Martínez-Serrano MA, Pereira JA, Sancho J, López-Cano M, Bombuy E, Hidalgo J. Risk of death after emergency repair of abdominal wall hernias. Still waiting for improvement. Langenbecks Arch Surg. 2010;395(5):551-6.
Kulah B, Kulacoglu IH, Oruc MT, Duzgun AP, Moran M, Ozmen MM, et al. Presentation and outcome of incarcerated external hernias in adults. Am J Surg. 2001;181(2):101-4.
Hachisuka T. Femoral hernia repair. Surg Clin North Am. 2003;83(5):1189-205.
Sarr MG, Bulkley GB, Zuidema GD. Preoperative recognition of intestinal strangulation obstruction. Prospective evaluation of diagnostic capability. Am J Surg. 1983;145(1):176-82.
Robinson A, Light D, Nice C. Meta-analysis of sonography in the diagnosis of inguinal hernias. J Ultrasound Med. 2013;32(2):339-46.
Defined LJ, Brooks DC. Approach to the adult with a groin hernia. UpToDate. 2024.
Bittner R, Montgomery MA, Arregui E, Bansal V, Bingener J, Bisgaard T, et al. Update of guidelines on laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia (International Endohernia Society). Surg Endosc. 2015;29(2):289-321.
Harissis HV, Douitsis E, Fatouros M. Incarcerated hernia: open or laparoscopic approach? Surg Laparosc Endosc Percutan Tech. 2009;19(5):e177-9.
Birindelli A, Sartelli M, Di Saverio S, Coccolini F, Ansaloni L, van Ramshorst GH, et al. 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias. World J Emerg Surg. 2017;12:37.
Atila K, Guler S, Inal A, Sokmen S, Karademir S, Bora S. Prosthetic repair of acutely incarcerated groin hernias: a prospective clinical observational cohort study. Langenbecks Arch Surg. 2010;395(5):563-8.
Choi SB, Hong KD, Lee JS, Han HJ, Kim WB, Song TJ, et al. Management of inguinal hernia in patients with liver cirrhosis and ascites. J Korean Surg Soc. 2011;80(4):272-7.
Yang GP, Chan CT, Lai EC, Chan OC, Tang CN, Li MK. Laparoscopic versus open repair for strangulated groin hernias: 188 cases over 4 years. Asian J Endosc Surg. 2012;5(2):71-5.
Referanslar
HerniaSurge Group. International guidelines for groin hernia management. Hernia. 2018;22(1):1-165.
Fitzgibbons RJ Jr, Forse RA. Clinical practice. Groin hernias in adults. N Engl J Med. 2015;372(8):756-63.
Öberg S, Andresen K, Rosenberg J. Etiology of Inguinal Hernias: A Comprehensive Review. Front Surg. 2017;4:52.
Martínez-Serrano MA, Pereira JA, Sancho J, López-Cano M, Bombuy E, Hidalgo J. Risk of death after emergency repair of abdominal wall hernias. Still waiting for improvement. Langenbecks Arch Surg. 2010;395(5):551-6.
Kulah B, Kulacoglu IH, Oruc MT, Duzgun AP, Moran M, Ozmen MM, et al. Presentation and outcome of incarcerated external hernias in adults. Am J Surg. 2001;181(2):101-4.
Hachisuka T. Femoral hernia repair. Surg Clin North Am. 2003;83(5):1189-205.
Sarr MG, Bulkley GB, Zuidema GD. Preoperative recognition of intestinal strangulation obstruction. Prospective evaluation of diagnostic capability. Am J Surg. 1983;145(1):176-82.
Robinson A, Light D, Nice C. Meta-analysis of sonography in the diagnosis of inguinal hernias. J Ultrasound Med. 2013;32(2):339-46.
Defined LJ, Brooks DC. Approach to the adult with a groin hernia. UpToDate. 2024.
Bittner R, Montgomery MA, Arregui E, Bansal V, Bingener J, Bisgaard T, et al. Update of guidelines on laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia (International Endohernia Society). Surg Endosc. 2015;29(2):289-321.
Harissis HV, Douitsis E, Fatouros M. Incarcerated hernia: open or laparoscopic approach? Surg Laparosc Endosc Percutan Tech. 2009;19(5):e177-9.
Birindelli A, Sartelli M, Di Saverio S, Coccolini F, Ansaloni L, van Ramshorst GH, et al. 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias. World J Emerg Surg. 2017;12:37.
Atila K, Guler S, Inal A, Sokmen S, Karademir S, Bora S. Prosthetic repair of acutely incarcerated groin hernias: a prospective clinical observational cohort study. Langenbecks Arch Surg. 2010;395(5):563-8.
Choi SB, Hong KD, Lee JS, Han HJ, Kim WB, Song TJ, et al. Management of inguinal hernia in patients with liver cirrhosis and ascites. J Korean Surg Soc. 2011;80(4):272-7.
Yang GP, Chan CT, Lai EC, Chan OC, Tang CN, Li MK. Laparoscopic versus open repair for strangulated groin hernias: 188 cases over 4 years. Asian J Endosc Surg. 2012;5(2):71-5.
