Diyafragma fýtýklarýnýn onarýmý: 70 olgunun retrospektif analizi

AMAÇ: Konjenital ve travmatik diyafragma fýtýklarý (DF) ciddi morbidite ve mortalite nedeni olabilen solunumsal ve gastrointestinal komplikasyonlara yol açabilmektedir. Bu çalýþmada, komplike veya komplike olmayan diyafragma fýtýklarýnýn cerrahi onarýmýna dair deneyimimizi paylaþmayý amaçladýk. GEREÇ VE YÖNTEM: 2009-2023 arasýnda DF nedeniyle acil veya elektif þartlarda ameliyat edilen hastalar geriye dönük olarak analiz edildi. De-mografik özellikleri, öyküleri, semptomlarý, fýtýk etyolojileri, bilgisayarlý tomografi bulgularý, ameliyat teknikleri ve postoperatif sonuçlarý kaydedildi. BULGULAR: Olgularýn ortalama yaþý 51.5±18.5 olup 29’u kadýn 41’i erkekti. Fýtýk etyolojisi sýrasýyla, konjenital (%40), travmatik (%32.8), spontan (%14.3) ve iyatrojenik (%12.8) idi. Ortalama fýtýk defekti 7.3±2.76 cm (3-15 cm) olup fýtýklarýn %84’ü sol tarafta idi. Olgularýn %60’ý laparoskopik, %11.4’ü laparotomi ile opere edildi. Laparoskopiden açýða geçiþ oraný %24.3 idi. Hastalarýn %48’inde dual yama kullanýldý ve %34’ünde primer sütü-rasyon uygulandý. Postoperatif mortalite oraný %7.1 idi.
SONUÇ: Diyafragma fýtýklarý abdominal organ strangülasyonu, pulmoner ve kardiyak komplikasyonlar nedeniyle önemli bir morbidite ve mortalite nedenidir. Diyafragma fýtýðý tanýsý konulduðunda laparoskopik veya açýk cerrahi tercih edilmesi gereken tedavi yöntemidir.

Repair of diaphragmatic hernias: Retrospective analysis of 70 cases

BACKGROUND: Congenital and traumatic diaphragmatic hernias (DH) can lead to respiratory and gastrointestinal complications that can be the cause of serious morbidity and mortality. In this study, we aimed to share our experience with the surgical repair of complicated or non-complicated DH.
METHODS: Patients who were operated on under emergency or elective conditions with the diagnosis of DH between 2009 and 2023 were analyzed retrospectively. Demographic characteristics, histories, symptoms, etiology of DH, computed tomography find-ings, surgical techniques, and postoperative outcomes of the patients were recorded.
RESULTS: The mean age of the cases was 51.5±18.5, and 29 were female and 41 were male. Hernia etiology was found to be con-genital (40%), traumatic (32.8%), spontaneous (14.3%), and iatrogenic (12.8%), respectively. The mean diameter of the defects was 7.3±2.76 cm (range: 3–15 cm), and 84% of the defects were on the left side. Sixty percent of the cases were treated by laparoscopic surgery and 11.4% by laparotomy. The conversion rate from laparoscopic to open was 24.3%. Dual mesh was used in 48% of the pa-tients, and primary suturing was applied in 34%. The postoperative mortality rate was 7.1%.
CONCLUSION: DH is an important cause of morbidity and mortality due to abdominal organ strangulation and pulmonary and cardiac complications. When a DH is diagnosed, laparoscopic or open surgery is the treatment that should be preferred.