Thiol/disülfid hemostazý, delta nötrofil indeks ve iskemi modifiye albümin’in inkarsere ve strangüle herni olgularýnda klinik etkinliði

AMAÇ: Ýnkarsere ve/veya strangüle inguinal herni tanýsý ile baþvuran hastalarýn tedavisi çoðu zaman cerrahidir. Strangülasyon ve nekroz mevcut ise laparotomi ihtiyacý doðar ve buna baðlý morbidite riskinde artýþ olabilir. Günümüzde ameliyat öncesinde baðýrsakta iskemi ve nekroz olup olmadýðýný net olarak saptamak mümkün deðildir. Bu çalýþmada, thiol/disülfid hemostazý, delta nötrofil indeks (DNÝ) ve iskemi modifiye albumin (ÝMA) para-metrelerinin inkarsere ve strangüle herni olgularýnda klinik etkinliðini araþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Nisan 2021- Kasým 2021 yýllarýnda genel cerrahi polikliniðine inguinal herni nedeniyle ve acil servise inkarsere ve/veya stran-güle herni ön tanýsý ile baþvuran hastalar çalýþmaya dahil edildi. Hastalar dört gruba ayrýldý; inguinal herni nedeniyle elektif onarým yapýlan hastalar (Grup 1), inkarsere herni nedeniyle operasyon yapýlmadan gözlemlenen hastalar (Grup 2), inkarserasyon nedeni ile baðýrsak rezeksiyonu yapýlmadan fýtýk onarýmý yapýlan hastalar (Grup 3) ve strangülasyon nedeni ile baðýrsak rezeksiyonu uygulanan hastalar (Grup 4) þeklinde gruplandýrýldý. Ek olarak Grup 1'de olan hastalar kontrol grubu, Grup 2, 3 ve Grup 4'de olan hastalar inkarsere/strangüle herni grubu olarak tanýmlandý. Hastalarýn demogra-fik verileri, yatýþ süresi, vücut kitle indeksi (VKÝ), ek hastalýklarý, öykü ve fizik muayene bulgularý, radyolojik tetkikleri, uygulanan tedavi, WBC (White blood cells), laktat, DNÝ, thiol-disülfid ve ÝMA parametreleri deðerlendirildi.
BULGULAR: Ýnkarsere/strangüle grubundaki WBC, disülfid/native thiol, disülfid/total thiol ve ÝMA deðerleri kontrol grubuna göre daha yüksek iken, kontrol grubundaki native thiol, total thiol deðerleri inkarsere/strangüle grubuna göre daha yüksek olarak izlendi (p<0,05). Laktat bakýmýndan gruplar arasýnda istatistiksel olarak anlamlý bir farklýlýk bulunmamakta iken (p>0.05), Grup 4 hastalarda WBC ortalamasý Grup 1’e göre, baðýrsak rezeksiyonu ve anastomoz yapýlanlarda DNÝ ortalamasý ise takiple taburcu edilen gruba göre daha yüksek olarak izlendi (p<0.05).
SONUÇ: Ýnkarsere/strangüle herni olgularýnda, thiol disülfid hemostazý, ÝMA ve DNÝ paremetrelerinin ameliyat öncesinde deðerlendirilmesinin; intraoperatif olarak karþýlaþýlabilecek zorluklarý ve hastaya uygulanacak olan cerrahi iþlemi önceden tahmin etmede etkin ve kolay uygulanabilir bir yöntem olabileceði düþüncesindeyiz.

Investigation of the clinical efficacy of thiol–disulfide homeostasis, delta neutrophil index, and ischemia-modified albumin in cases of incarcerated and strangulated hernia

BACKGROUND: The treatment of patients presenting with the diagnosis of incarcerated and/or strangulated inguinal hernia is mostly surgery. If strangulation and necrosis are present, the need for laparotomy arises, which may increase the risk of morbidity. Currently, it is not possible to clearly determine whether there is bowel ischemia and necrosis before surgery. In this study, we aimed to investigate the clinical efficacy of the thiol–disulfide homeostasis, delta neutrophil index (DNI), and ischemia-modified albumin (IMA) parameters in incarcerated and strangulated hernia cases.
METHODS: Patients that presented to the general surgery outpatient clinic due to inguinal hernia or to the emergency department of the hospital with a preliminary diagnosis of incarcerated and/or strangulated hernia in April 2021-November 2021 were included in the study. The patients were divided into the following four groups: patients that underwent elective repair for inguinal hernia (Group 1), those who were followed up without surgery due to incarcerated hernia (Group 2), those who underwent hernia repair without bowel resection due to incarceration (Group 3), and those who underwent bowel resection due to strangulation (Group 4). Group 1 was defined as the control group, while Groups 2, 3, and Group 4 were evaluated as the incarcerated/strangulated hernia group. The demographic data of the patients, length of hospital stay, body mass index, comorbidities, medical history and physical examina-tion findings, radiological examinations, treatments applied, white blood cell (WBC) count, lactate, and DNI, thiol–disulfide and IMA parameters were evaluated.
RESULTS: The WBC count, disulfide/native thiol, disulfide/total thiol, and IMA values were significantly higher in the incarcerated/strangulated hernia group than in the control group, while the native thiol and total thiol values were higher in the latter than in the former (P<0.05). There was no statistically significant difference between the groups in terms of lactate (P>0.05), but the mean WBC count was higher in Group 4 compared to Group 1, and the mean DNI was significantly higher among the patients who underwent bowel resection and anastomosis than in those that were followed up and discharged (P<0.05).
CONCLUSION: We consider that the preoperative evaluation of the thiol–disulfide homeostasis, IMA, and DNI parameters in incarcerated/strangulated hernia cases can be an effective and easily applicable method in predicting difficulties that may be encountered intraoperatively and the surgical procedure to be applied to the patient.