Ponad 7000 publikacji medycznych!
Statystyki za 2021 rok:
odsłony: 8 805 378
Artykuły w Czytelni Medycznej o SARS-CoV-2/Covid-19

Poniżej zamieściliśmy fragment artykułu. Informacja nt. dostępu do pełnej treści artykułu tutaj
© Borgis - Postępy Nauk Medycznych 5/2018, s. 260-264 | DOI: 10.25121/PNM.2018.31.5.260
Hady Razak Hady1, Paulina Wozniewska1, Maria Soldatow2, Jacek Lapinski2, Piotr Golaszewski1, Inna Diemieszczyk1, Dawid Groth1, Jacek Dadan1, Jerzy Robert Ladny1, 3
The characteristic and management of inguinal hernias based on the own experience
Charakterystyka i postępowanie w przypadku przepuklin pachwinowych oparte na własnym doświadczeniu
1Ist Department of General and Endocrine Surgery, University Clinical Hospital in Bialystok, Poland
2Surgery Department, Independent Public Health Care Center, Lapy, Poland
3Department of Emergency Medicine, Medical University of Bialystok, Poland
Streszczenie
Wstęp. Plastyka przepukliny pachwinowej jest powszechnie wykonywaną procedurą chirurgiczną na całym świecie. Pacjenci zwykle zgłaszają się do lekarza z wyczuwalnym wybrzuszeniem bądź bólem w okolicy pachwinowej, który wpływa negatywnie na jakość ich życia. Wytyczne sugerują postępowanie chirurgiczne w odniesieniu do wszystkich przepuklin objawowych w celu zmniejszenia objawów klinicznych oraz uniknięcia niekorzystnych powikłań.
Cel pracy. Celem niniejszej pracy było dostarczenie informacji o naturalnym przebiegu przepuklin pachwinowych z uwzględnieniem wieku, zawodu, chorób współistniejących oraz najczęściej zgłaszanych dolegliwości. Przeprowadzona została także analiza postępowania chirurgicznego.
Materiał i metody. Praca została oparta na analizie historii medycznych 365 pacjentów, których poddano zabiegom plastyki przepukliny pachwinowej w latach 2013-2017 w I Klinice Chirurgii Ogólnej i Endokrynologicznej Uniwersyteckiego Szpitala Klinicznego w Białymstoku oraz na Oddziale Chirurgicznym Samodzielnego Publicznego Zakładu Opieki Zdrowotnej w Łapach.
Wyniki. Ryzyko rozwoju przepukliny pachwinowej jest znacznie większe u mężczyzn niż u kobiet (317 vs 48 przypadków). Częstość występowania przepukliny rośnie z wiekiem i częściej pojawia się u pacjentów, którzy zajmują się pracą fizyczną (81% kobiet i 71% mężczyzn). Wyczuwalny guzek w okolicy pachwinowej był obecny w przypadku 64,5% kobiet oraz 61% mężczyzn. Drugim co do częstości objawem zgłaszanym przez pacjentów był ból w trakcie wysiłku fizycznego (52% kobiet i 57% mężczyzn). Najczęściej przeprowadzanym zabiegiem spośród otwartych metod była operacja Lichtensteina i dotyczyła 39,5% kobiet i 30,5% mężczyzn. W przypadku zabiegów laparoskopowych najliczniejszym dostępem chirurgicznym był TEP (21% kobiet i 36,5% mężczyzn).
Wnioski. Starszy wiek, płeć męska oraz wykonywanie pracy fizycznej są czynnikami ryzyka dla rozwoju przepukliny pachwinowej. Pacjenci najczęściej zgłaszają się do lekarza z powodu wyczuwalnego guzka w okolicy pachwinowej oraz dolegliwości bólowych w trakcie aktywności fizycznej. Postępowanie chirurgiczne jest niezbędne w celu uniknięcia niekorzystnych komplikacji. Operacje z użyciem siatek są preferowaną metodą zaopatrzenia przepukliny pachwinowej ze wzrastającą tendencją do wykonywania zabiegów laparoskopowych.
Summary
Introduction. Inguinal hernia repair is commonly performed surgical procedure all over the world. Patients usually report with the bulge or pain in the groin region that affects negatively their quality of life. The guidelines suggest surgical management for all symptomatic hernias in order to reduce clinical symptoms and avoid adverse complications.
Aim. The aim of the study was to assess data about the natural history of inguinal hernia including patients’ age, profession, comorbidities and most commonly reported complaints. The surgical treatment has also been analyzed.
Material and methods. The study was based on the analysis of the medical records of 365 patients who underwent inguinal hernia repair between 2013 and 2017 at the Ist Department of General and Endocrinological Surgery, University Hospital in Bialystok and at the Surgery Department at the Independent Public Health Care Center in Lapy.
Results. Men are more likely to develop inguinal hernia in comparison to women (317 vs 48 cases). The incidence of hernia increases with age and most commonly appears in patients who deal with physical work (81% of female cases and 71% of male cases). Palpable mass in groin region was present in 64.5% of women and 61% of men. Second most frequently reported symptom was pain during physical activity (52% of females and 57% of males). For open approaches, the Lichtenstein method has been performed most commonly and referred to 39.5% of women and 30.5% of men. Whereas, TEP repair was most frequently performed laparoscopic surgery (21% of women and 36.5% of men).
Conclusions. Older age, male sex and physical work are risk factors for developing an inguinal hernia. Patients most often report to the doctor due to the pain in groin region and palpable lump. The surgical treatment is essential to avoid adverse complications, thus the mesh repairs are recommended with the preference of performing laparoscopic procedures.
INTRODUCTION
Inguinal hernia repair is the most common procedure performed by general surgeons, estimated at more than 20 million hernias’ interventions every year around the world (1). Inguinal hernias comprises for up to 97% of groin hernias with the distinct dominance in occurrence in males (90.2% males vs. 9.8% females) (2). Except the male gender, other patient-related risk factors for developing an inguinal hernia include older age, positive family history, systemic connective tissue disorders and coexistence of hiatal hernia (3, 4). Smoking is also a potential risk factor for herniation, although its influence is uncertain. Some studies show that tobacco use changes the collagen metabolism causing the serologic turnover of type IV collagen, which increases the risk for inguinal hernia (5). However, recent research shows the negative link between smoking and development of inguinal hernia, which still remains unexplained (6). The cumulative work exposure causing the increased intraabdominal pressure is involved in lateral hernia formation. Studies show that prolonged standing or walking, frequent heavy lifting and total load of daily lifting activities are external risk factors for lateral hernia creation (7, 8). By definition, the inguinal hernia is a condition when part of an intestine or fat protrudes through the area of weakness in the groin region. The inguinal hernias have three components: the neck (opening in the abdominal wall), the sac, which is formed by the protrusion of the peritoneum, and the contents that include any tissue or organ that shifts through the neck to the hernia sac. The position of hernia sac towards the inferior epigastric vessels determines the division of inguinal hernia into direct (appears medially to the vessels) and indirect (localizes laterally to the epigastric vessels) (9). In some cases, hernial sacs are present on both sides of the inferior epigastric vessels. This condition is known as a pantaloon hernia and is defined as ipsilateral, concurrent direct and indirect hernias. The clinical manifestation of inguinal hernia includes the wide range of sympomts. Most frequently, patients complain of hernia, groin or lower abdomen pain, increased peristalsis, pain during sexual activity and lower urinary tract symptoms. Up to 7% of patients may remain asymptomatic (10-12).
Proper physical examination is essential in the diagnosis process of inguinal hernia. Firstly, the visual inspection of inguinal area should be performed to detect any bulge or asymmetry in groin region. Secondly, the inguinal area should be palpated in standing and supine position in order to reveal the presence of hernia. The examination should be performed in relaxed position and in the situation of increased intraabdominal pressure, thus the patient should be asked to cough or perform the Valsalva maneuver. The radiological investigation is needed when the clinical evaluation has not reveal any findings. Ultrasonography is usually the first choice test as it is widely available, inexpensive and has minimal complications. It has the overall sensitivity of 96.6% and specificity of 84.8% (13). If needed, magnetic resonance imaging or computer tomography may be used to verify the proper diagnosis. The only treatment of inguinal hernia is a surgical treatment that is based on the repair of the posterior wall of inguinal canal. The “watchful waiting” may be applied only to male patients with primary, minimally symptomatic or asymptomatic inguinal hernia (14). The open approaches are based on either pure tissues approximation or tension free mesh repair. The primary methods for tissue repairs include the Bassini, Shouldice, Halstead and McVay procedure. The Lichtenstein method is the most frequently performed open mesh-based technique. Totally extraperitoneal (TEP) repair and transabdominal preperitoneal (TAPP) repair are methods of laparoscopic surgery. In TEP method the mesh is inserted directly into the preperitoneal space, whereas, in the TAPP technique the preperitoneal space is reached through the peritoneal cavity. Recent study shows that sutured repairs are associated with a higher risk of reoperation for recurrence of hernia over 5 years compared with the open mesh and laparoscopic mesh repair. The overall recurrence rate in the non-mesh group was evaluated at 18.3%, in the open mesh group was 13.2% and in the laparoscopic mesh group was 11.2%. Other possible complications after surgical treatment of inguinal hernia include: bowel obstruction, bleeding, infection, late intraabdominal abscess, enterocutaneous fistula, seroma, hematoma, nonhealing wounds and chronic pain (15).
AIM
The aim of the study was to present the natural history of inguinal hernia including patients’ age and profession, most frequently reported complaints, comorbidities and surgical approaches for inguinal hernia repair.
MATERIAL AND METHODS
We analyzed the medical records of 365 patients who underwent inguinal hernia repair between 2013 and 2017 at the Ist Department of General and Endocrinological Surgery, University Hospital in Bialystok and at the Surgery Department at the Independent Public Health Care Center in Lapy. The procedure has been performed by the same operating team – operator and two assistants. Factors such as, age, profession, coexisting diseases, clinical symptoms and type of inguinal hernia have been analyzed. Different surgical approaches have also been investigated including changes in the methods used within studied period.
RESULTS
The study group included 365 patients age 21-72, average age 59.5. Males accounted for 87% (n = 317) with average age of 56 years, while the percentage of female patients was 13% (n = 48) with the average age of 63 years. According to age by decade, almost half of women was at their 6th decade of life. In case of men, no peak of incidence has been observed, but almost 77% of male patients were between 31 and 60 years old (fig. 1).
Fig. 1. The incidence of inguinal hernia according to age by decade
The majority of patients reported with inguinal hernia were involved in physical work (81% of women and 71% of men). One third of females and about 20% of males were diagnosed with comorbidities that could possibly lead to hernia formation such as: respiratory tract infections with coexisting cough (12.5% of females and 12% of males), asthma (14.5% of females and 3.4% of males) and the history of cancer (6% of females and 4.5% of males). More than 25% of all patients also reported the injury preceding the appearance of inguinal hernia such as the jump down from the stairs or heavy lifting (tab. 1, fig. 2).
Tab. 1. The occurrence of inguinal hernia according to occupational activity, injuries and comorbidities
 Mental work (%)Physical work (%)Injuries (%)Coexisting diseases (%)
Female9 (18.8%)39 (81.3%)11 (22.9%)16 (33.3%)
Male91 (28.2%)226 (71.3%)87 (27.4%)65 (20.5%)
Fig. 2. Coexisting diseases

Powyżej zamieściliśmy fragment artykułu, do którego możesz uzyskać pełny dostęp.
Mam kod dostępu
  • Aby uzyskać płatny dostęp do pełnej treści powyższego artykułu albo wszystkich artykułów (w zależności od wybranej opcji), należy wprowadzić kod.
  • Wprowadzając kod, akceptują Państwo treść Regulaminu oraz potwierdzają zapoznanie się z nim.
  • Aby kupić kod proszę skorzystać z jednej z poniższych opcji.

Opcja #1

19

Wybieram
  • dostęp do tego artykułu
  • dostęp na 7 dni

uzyskany kod musi być wprowadzony na stronie artykułu, do którego został wykupiony

Opcja #2

49

Wybieram
  • dostęp do tego i pozostałych ponad 7000 artykułów
  • dostęp na 30 dni
  • najpopularniejsza opcja

Opcja #3

119

Wybieram
  • dostęp do tego i pozostałych ponad 7000 artykułów
  • dostęp na 90 dni
  • oszczędzasz 28 zł
Piśmiennictwo
1. Kingsnorth A, LeBlanc K: Hernias: inguinal and incisional. Lancet 2003; 362(9395): 1561-1571.
2. Burcharth J, Pedersen M, Bisgaard T et al.: Nationwide prevalence of groin hernia repair. PLoSOne 2013; 8(1): e54367.
3. Ruhl CE, Everhart JE: Risk factors for inguinal hernia among adults in the US population. Am J Epidemiol 2007; 165(10): 1154-1161.
4. Öberg S, Andresen K, Rosenberg J: Etiology of inguinal hernias: a comprehensive review. Front Surg 2017; 4: 52.
5. Henriksen NA, Mortensen JH, Sorensen LT et al.: The collagen turnover profile is altered in patients with inguinal and incisional hernia. Surgery 2015; 157: 312-321.
6. Hemberg A, Holmberg H, Norberg M et al.: Tobacco use is not associated with groin hernia repair, a population-based study. Hernia 2017; 21(4): 517-523.
7. Vad MV, Frost P, Bay-Nielsen M et al.: Impact of occupational mechanical exposures on risk of lateral and medial inguinal hernia requiring surgical repair. Occup Environ Med 2012; 69(11): 802-809.
8. Vad MV, Frost P, Rosenberg J et al.: Inguinal hernia repair among men in relation to occupational mechanical exposures and lifestyle factors: a longitudinal study. Occup Environ Med 2017; 74(11): 769-775.
9. Fitzgibbons RJ Jr, Forse RA: Clinical practice. Groin hernias in adults. N Engl J Med 2015; 372(8): 756-763.
10. Perez Lara FJ, Del Rey MA, Oliva MH: Do we really know the symptoms of inguinal hernia? Hernia 2015; 19(5): 703-712.
11. dos Reis RB, Rodrigues Neto AA, Oliveira Reis L et al.: Correlation between the presence of inguinal hernia and the intensity of lower urinary tract symptoms. Acta Cir Bras 2011; 26(2): 125-128.
12. Tolver MA, Rosenberg J: Pain during sexual activity before and after laparoscopic inguinal hernia repair. Surg Endosc 2015; 29(12): 3722-3725.
13. Robinson A, Light D, Nice C: Meta-analysis of sonography in the diagnosis of inguinal hernias. J Ultrasound Med 2013; 32(2): 339-346.
14. Simons MP, Aufenacker T, Bay-Nielsen M et al.: European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 2009; 13(4): 343-403.
15. Kokotovic D, Bisgaard T, Helgstrand F: Long-term recurrence and complications associated with elective incisional hernia repair. JAMA 2016; 316(15): 1575-1582.
16. Primatesta P, Goldacre MJ: Inguinal hernia repair: incidence of elective and emergency surgery, readmission and mortality. Int J Epidemiol 1996; 25: 835-839.
17. Zendejas B, Ramirez T, Jones T et al.: Incidence of inguinal hernia repairs in Olmsted County, MN: a population-based study. Ann Surg 2013; 257(3): 520-526.
18. Kang SK, Burnett CA, Freund E et al.: Hernia: is it a work-related condition? Am J Ind Med 1999 Dec; 36(6): 638-644.
19. Garvey JF, Read JW, Turner A: Sportsman hernia: what can we do? Hernia 2010; 14(1): 17-25.
20. Morales-Conde S, Socas M, Barranco A: Sportsmen hernia: what do we know? Hernia 2010; 14(1): 5-15.
21. Hendry PO, Paterson-Brown S, de Beaux A: Work related aspects of inguinal hernia: a literature review. Surgeon 2008; 6(6): 361-365.
22. Pathak S, Poston GJ: It is highly unlikely that the development of an abdominal wall hernia can be attributable to a single strenuous event. Ann R Coll Surg Engl 2006; 88(2): 168-171.
23. LeBlanc KE, LeBlanc LL, LeBlanc KA: Inguinal hernias: diagnosis and management. Am Fam Physician 2013; 87(12): 844-848.
24. de Goede B, Wijsmuller AR, van Ramshorst GH et al.: Watchful waiting versus surgery of mildly symptomatic or asymptomatic inguinal hernia in men aged 50 years and older: a randomized controlled trial. Ann Surg 2018; 267(1): 42-49.
25. Lockhart K, Dunn D, Teo S et al.: Mesh versus non-mesh for inguinal and femoral hernia repair. Cochrane Database Syst Rev 2018; 9: CD011517.
26. Grant AM; EU Hernia Trialists Collaboration: Open mesh versus non-mesh repair of groin hernia: meta-analysis of randomized trials based on individual patient data. Hernia 2002; 6(3): 130-136.
27. Pavlidis TE, Atmatzidis KS, Lazaridis CN et al.: Comparison between modern mesh and conventional non-mesh methods of inguinal hernia repair. Minerva Chir 2002; 57(1): 7-12.
28. Scheuermann U, Niebisch S, Lyros O et al.: Transabdominal Preperitoneal (TAPP) versus Lichtenstein operation for primary inguinal hernia repair – A systematic review and meta-analysis of randomized controlled trials. BMC Surg 2017; 17(1): 55.
29. Myers E, Browne KM, Kavanagh DO et al.: Laparoscopic (TEP) versus Lichtenstein inguinal hernia repair: a comparison of quality-of-life outcomes. World J Surg 2010; 34(12): 3059-3064.
30. HerniaSurge Group: International guidelines for groin hernia management. Hernia 2018; 22(1): 1-165.
otrzymano: 2018-09-06
zaakceptowano do druku: 2018-09-27

Adres do korespondencji:
*Hady Razak Hady
Ist Department of General and Endocrine Surgery University Clinical Hospital in Bialystok
24A M. Skłodowskiej-Curie Str., 15-276 Bialystok, Poland
Phone: +48 (85) 8318672
E-mail: hadyrazakh@wp.pl

Postępy Nauk Medycznych 5/2018
Strona internetowa czasopisma Postępy Nauk Medycznych