Serkan ERKAN, Hakan YABANOĞLU, Ramazan GÜNDOĞDU, Murat KUŞ, Murathan ERKENT

Erişkin Konjenital Diafragma Hernisi Cerrahi Tedavi Sonuçlarımız

Diyafragmatik herni, diyaframdaki defekt neticesinde batın organlarının toraksa yer değiştirmesidir. Konjenital ya da edinsel nedenli olabilir (1). Konjenital diafragma hernileri bochadalec hernisi ve morgagni hernisidir. Edinsel nedenli olanlara göre daha sık olup görülme sıklığı 1-5/1000’dir. Edinsel diafram hernilerininen sık nedeni travmadır. Kendiliğinden veya iyatrojenik olarakda ortaya çıkabilir (2). Tedavisinde cerrahi onarım önerilmektedir. Yazımızda konjenital diyafragma hernisi cerrahi tedavi deneyimimizi sunmayı amaçladık. Merkezimizde konjenital diyafragma hernisi nedeniyle Ocak 2011-Aralık 2020 tarihleri arasında ameliyat edilen hastaların dosyaları geriye dönük olarak incelendi. Travma ve iatrojenik sebepli fıtığı olan hastalar çalışma dışı bırakıldı. Çalışmamıza kriterlere uyan 12 hasta dahil edildi. Bu hastaların demografik verileri, başvuru şikayetleri, preoperatif görüntülemeleri, defekt lokalizasyonları, yapılan cerrahi işlemleri, hastanede yatış süreleri, erken dönem komplikasyonları, nüks ve mortalite oranları kaydedildi. Hastaların 7’si erkek, 5’i kadındı. Yaş ortalaması 60 (34-84) yıl idi. Hikayeleri detaylı sorgulandığında travma veya geçirilmiş cerrahi gibi iatrojenik sebepler yoktu. Tüm hastaların tanıları bilgisayarlı tomografi ile doğrulanmıştı. Defekt lokalizasyonları sağ ve solda eşit sayıdaydı. Hastaların 5’ine primer onarım+mesh herniorafi, 4 üne primer onarım, 3 tanesine sadece mesh ile onarım yapılmıştı. Hastanede ortalama kalış süresi 4 (1-8) gündü. Erken dönemde 2 hastada pulmoner emboli, 2 hastada yara problemi dışında erken ve geç dönem komplikasyon görülmemişti. 2 hastanın tedavisi ani gelişen pulmoner emboli nedeni ile mortalite ile neticelenmişti. Konjenital diyafragma hernileri, çoğunlukla çocuk yaşta tanı alsa da nadiren de olsa ileri yaşlarda da tanı alabilmektedir. Tedavisi cerrahi olup bu tedavinin başarısı yüksek, morbidite ve mortalitesi düşüktür.

Anahtar Kelimeler:

Bochdalec Hernisi, Edinsel, Diyafragmatik Herni, Konjenital, Morgagni Hernisi

Adult Congenital Diaphragmatic Hernia Treatment Results

Diaphragmatic hernia is the displacement of the abdominal organs to the thorax as a result of the diaphragm defect. It may be congenital or acquired (1). Congenital diaphragm hernia is bochadalec hernia and morgagni hernia. It is more common than those with acquired causes and its incidence is 1-5/1000. Trauma is the most common cause of acquired diaphragmatic hernias. It may occur spontaneously or iatrogenically (2). Surgical repair is recommended in its treatment. We aimed to present our experience in congenital diaphragmatic hernia surgery. The files of patients, who were operated on for congenital diaphragmatic hernia between January 2011 and December 2020 in our center were retrospectively reviewed. Twelve patients, who met the criteria were included in our study. Patients with hernia due to trauma and iatrogenic reasons were excluded from the study. Demographic data, admission complaints, preoperative imaging, defect localization, surgical procedures performed, length of hospital stay, early complications, relapse and mortality rates of these patients were recorded. Seven of the patients were male and 5 were female. The average age was 60 (34-84 min-max) year. Six patients were admitted to the emergency department with acute complaints. When their stories were questioned in detail, there were no iatrogenic reasons such as trauma or previous surgery. Diagnoses of all patients were confirmed by computerized tomography. Defect localizations were equal on the right and left. 5 of the patients underwent primary repair + mesh herniorraphy, 4 of them primary repair, and 3 of them repair with mesh alone. Average length of stay in the hospital was 4 (1-8) days. There were no early or late complications, except embolism in 2 patients and wound problems in 2 patients in the early period. Mortality was seen in 2 patients. Although congenital diaphragmatic hernias are mostly diagnosed in childhood, they can rarely be diagnosed in advanced ages. The treatment is surgical and the success of this treatment is high, morbidity and mortality are low.

Keywords:

Bochdalec Hernia, Acquired, Diaphragmatic Hernia, Congenital, Morgagni Hernia,

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