Factors affecting morbidity in urgent repair of abdominal wall hernia with intestinal incarceration in adults

BACKGROUND
The aim of this study was to investigate factors that affect morbidity in adults with incarcerated intestinal hernia of the abdominal wall.
METHODS
124 patients with a mean age of 61±13.87 years (73 males) underwent emergency surgery for incarcerated intestinal hernia between March 1999 and March 2008. The median duration of the hernia was 5 years (0.1-30). Type and duration of hernia, accompanying diseases, surgical procedure, and operation-related complications were retrospectively evaluated.
RESULTS
Twenty-five patients (20%) had complications. Twelve patients (10%) had surgical site infection and 10 patients (8%) had septic complications. Four patients (3%) died in the postoperative period. Out of 40 patients developing strangulation, 18 underwent bowel resection. The only independent variable concerning bowel resection other than inguinal hernia was found to be ventral hernia (p=0.039). There was no statistical significance between duration of hernia and incarceration and complications. The rate of complications was significantly high in the patients with accompanying diseases (p<0.001). The relation between age and complications was also significant (p=0.034). Multivariate analyses showed high ASA scores as the only independent variable for development of complications (p<0.001).
CONCLUSION
Patients with comorbid diseases and high ASA scores should be informed about the elevated risk of complications, and scheduled surgery before the development of incarceration should be recommended.

Ýntestinal inkarserasyon için acil karýn duvarý fýtýk onarýmý yapýlan eriþkinlerde morbiditeyi etkileyen faktörler

AMAÇ
Bu çalýþmanýn amacý eriþkin hastalarda oluþan intestinal inkarserasyonlu karýn duvarý fýtýklarýnda morbiditeyi etkileyen faktörleri araþtýrmaktýr.
GEREÇ VE YÖNTEM
Mart 1999-Mart 2008 tarihleri arasýnda 124 olgu (73 erkek) inkarsere intestinal fýtýk tanýsý ile acil ameliyat edildi. Olgularýn yaþ ortalamasý 61±13,87 idi. Ortanca fýtýk süresi 5 yýl (0,1-30) bulundu. Fýtýk tipi, fýtýk süresi, yandaþ hastalýklar, uygulanan cerrahi tedavi ve ameliyat sonrasý komplikasyon bilgileri geriye dönük araþtýrýldý.
BULGULAR
Yirmi beþ hastada (%20) komplikasyon geliþti. On iki hastada (%10) cerrahi alan enfeksiyonu, 10 hastada (%8) septik komplikasyonlar oluþtu. Dört hasta (%3) ameliyat sonrasý dönemde kaybedildi. Strangülasyon geliþmiþ 40 olgunun 18’ine baðýrsak rezeksiyonu yapýldý. Baðýrsak rezeksiyonu yapýlmasýyla iliþkili tek baðýmsýz deðiþkenin kasýk fýtýðý dýþýndaki fýtýklar olduðu görüldü (p=0,039). Fýtýk süresi ve inkarserasyon süresi ile komplikasyonlar arasýnda anlamlý bir iliþki saptanmadý. Yandaþ hastalýðý olanlarda komplikasyon oranlarý anlamlý derecede yüksek idi (p<0,001). Yaþ ile komplikasyon geliþimi arasýnda da anlamlý iliþki bulundu (p=0,034). Çok deðiþkenli analizde komplikasyon oluþumunda tek baðýmsýz deðiþkenin ASA skoru olduðu saptandý (p<0,001).
SONUÇ
Yandaþ hastalýðý olan ve ASA skoru yüksek hastalarda komplikasyon oraný yüksek olduðundan fýtýk boðulmasý geliþmeden önce planlý ameliyat yapýlmasý önerilir.