Comprehensive Retrospective Analysis of Inguinal Hernias and Our Experiences with Special Hernias

Year 2024, , 110 - 115, 30.08.2024

Ramazan Serdar Arslan , Reşad Beyoğlu , Yavuz Koca , Ahmet Emre Yenipazar

https://doi.org/10.30565/medalanya.1463858

Abstract

Aim: This study aims to review specific types of inguinal hernias over the past three years and analyze the surgical decision-making processes based on recent literature.

Materials and Methods: A retrospective review was conducted of 1,159 patients who underwent inguinal hernia surgery at Servergazi State Hospital between January 1, 2021, and December 31, 2023. Data analyzed included patient demographics, hernia types, locations, surgical methods, and complications. Special hernias, including Amyand's, Littre's, and Richter's hernias, were specifically identified and reviewed.

Results: Among the 1,159 patients, 113 were female (9.7%) and 1,046 were male (90.3%). The average age was 47.8 years for females and 58.6 years for males. Hernia types included 838 inguinal (72.3%), 267 femoral (23.1%), and 54 recurrent (4.6%). Specific hernias identified included 4 cases of Amyand's hernia (0.34%), 2 cases of Littre's hernia (0.17%), and 1 case of Richter's hernia (0.08%). Surgical approaches consisted of 83.7% open surgery and 16.3% laparoscopic procedures, with meshplasty performed in 96.5% of cases. Complications were infrequent: seroma in 3.9%, hematoma in 1.8%, wound infection in 2.8%, and recurrence in 0.4%. Specific hernias required additional procedures such as appendectomy for Amyand's hernia and diverticulectomy for Littre's hernia, with no complications reported during follow-up.

Conclusion: Inguinal hernias often contain omental tissue, but special hernias like Amyand's (appendix), Littre's (Meckel’s diverticulum), and Richter's (intestinal wall) necessitate thorough examination. Amyand's hernia, which can range from incidental findings to acute appendicitis, benefits from mesh repair and appendectomy if needed. Littre’s hernia requires diverticulectomy in addition to hernia repair. Richter's hernia, presenting with varied symptoms, should be managed with direct inspection and appropriate repair. The increasing use of minimally invasive techniques may lead to a higher incidence of Richter's hernia. Tailoring surgical strategies to the type of hernia ensures optimal outcomes.

Keywords

inguinal hernia, Amyand's hernia, Littre's Hernia, Richter's hernia

Kasık Fıtıklarının Kapsamlı Retrospektif Analizi ve Özel Fıtıklardaki Deneyimlerimiz

Abstract

Amaç: Bu çalışma inguinal herni nedeniyle son üç yılda opere edilen hastalardaki özel fıtıkları gözden geçirmek ve güncel literatüre dayalı cerrahi yönetimini ve karar alma süreçlerini analiz etmeye amaçlamaktadır.

Yöntem: 1 Ocak 2021 ile 31 Aralık 2023 tarihleri arasında Servergazi Devlet Hastanesi'nde kasık fıtığı ameliyatı geçiren 1159 hastada retrospektif olarak incelendi. Hastaların demografik verileri, fıtık tipleri, yerleşim yerleri, cerrahi yöntemler, hastanede kalış süreleri ve komplikasyonlar analiz edildi. Amyand, Littre ve Richter gibi özel fıtıklar tanımlandı ve incelendi.

Bulgular: 1159 hasta arasında 113'ü kadın (%9.7) ve 1046'sı erkekti (%90.3). Kadınlarda ortalama yaş 47.8, erkeklerde ise 58.6 idi. Fıtık tipleri arasında 838 inguinal (%72.3), 267 femoral (%23.1) ve 54 nüks herni (%4,6) idi. Belirlenen spesifik fıtıklar dört Amyand (%0,34), iki Littre (%0,17) ve bir Richter (%0,08) herni idi. Cerrahi yaklaşımlar %83,7 açık ve %16,3 laparoskopikti; vakaların %96,5'inde greftli onarım yapılmıştı. Komplikasyonlar oranları düşüktü; %3.9'unda seroma, %1,8'inde hematom, %2,8'inde yara enfeksiyonu ve %0,4'ünde nüks herni görüldü. Spesifik fıtıklar, Amyand için apendektomi ve Littre için divertikülektomi ile birlikte greftli onarım tercih edilmişti. Richter hernisine mesh plug uygulanmıştı. Spesifik fıtıkların 10.gün ve birinci ay takiplerinde hiçbir komplikasyon bildirilmedi.

Sonuç: İnguinal hernilerde fıtık kesesi içerisinde sıklıkla omental doku bulunur, ancak Amyand (apandisit), Littre (Meckel divertikülü) ve Richter (bağırsak duvarı) gibi özel fıtıklar dikkatli inceleme gerektirir. Herni kesesi içerisinde saptanan dokuya göre tedavi stratejisi değişmektedir. Greftli veya anatomik onarım cerrahın peroperatif bulgularına göre karar vermesi gereken bir durumdur.

Keywords

Amyand fıtığı, Littre fıtığı, Richter fıtığı, inguinal herni

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