Öz
Amaç: Umblikal herni çocukluk çağında sıkça görülen karın ön duvarı defektidir. Defekt doğumda mevcut olmasına rağmen çocukluk çağının diğer hernilerinden farklı olarak ameliyat gerekmeden zamanla kendiliğinden kapanabilir. Ancak bu herniler spontan kapanmazsa acil ameliyat gerektiren komplikasyonlar gelişebilir. Bu çalışmada umblikal herni tanısı alan hastalarda spontan kapanma insidansının ve buna etki eden faktörlerin, takipte gelişebilecek komplikasyonların ve ameliyat endikasyonlarının belirlenmesi, hastaların takiplerini planlarken dikkat edilmesi gereken hususların ortaya konması amaçlanmıştır.
Gereç ve Yöntemler: Kliniğimizde Ocak 2006-Aralık 2011 tarihleri arasında umblikal herni tanısı alan, takip ve tedavisi yapılan 1928 hasta çalışmaya dahil edildi. Retrospektif kohort olarak planlanan bu çalışmada hastaların mevcut umblikal herni boyutları, ek hastalıkları, demografik özellikleri incelendi. Ameliyat olan hastaların ameliyat verileri, komplikasyonları ve postoperatif takipleri değerlendirildi.
Bulgular: Hastaların umblikal hernilerinin spontan kapanma oranı %60 olarak bulundu. Erkeklerde umblikal herninin spontan kapanma oranları daha yüksek olduğu, kızlarda ise ameliyat olma oranının daha yüksek olduğu görüldü. Kızlarda inkarserasyon riski erkeklere göre yüksek bulundu. Defekt boyutu arttıkça spontan kapanma oranı azalmakta olduğu görüldü. Hastalarda izlenen ek hastalıkların umblikal herninin spontan kapanmasına etkisi olmadığı saptandı. İnkarserasyon nedeniyle acil operasyon oranının (%2) düşük olduğu gözlendi. Hastaların %1’inde strangülasyon saptandı. İnkarserasyon izlenen hastaların tamamı Lassaletta grup 2’de yer almaktaydı (defekt çapı 0.5-1.5 cm).
Sonuç: Umblikal herninin tedavisinde konsevatif izlem hala en kabul gören ve en güvenli yöntemdir. Umblikal hernilerde inkarserasyon ve strangülasyon oldukça nadir görülmektedir. Umblikal herni komplike hale gelmiş olsa dahi cerrahi tedavisi mümkündür ve peroperatif-postoperatif komplikasyon oranları oldukça düşüktür. İnkarserasyon nedeniyle uzun dönem morbidite ve mortalite literatürde saptanmamıştır.
Anahtar Kelimeler
Kaynakça
- Weber TR. Umbilical and Other Abdominal Wall Hernias. In: Ashcraft’s Pediatric Surgery. 5 edn. Edited by Ashcraft KW, HolcombIII GW, Murphy JP: Elsevier 2005: 637-9.
- Malangoni MA, Gagliardi RJ. Hernias. in: Sabiston Textbook of Surgery. edn. Edited by Towsend CM, Evers BM, Beauchamp RD, Mattox KL 2004:1199-218.
- Başaklar AC. Göbek ve Karın Ön Duvarı Anomalileri. in: Bebek ve Çocukların Cerrahi ve Ürolojik Hastalıkları edn. Edited by Başaklar AC. Ankara: Palme 2006:1051-81.
- Beres A, Christison-Lagay ER, Romao RL, Langer JC. Evaluation of Surgisis for patch repair of abdominal wall defects in children. J Pediatr Surg 2012;47:917-9.
- Venclauskas L, Silanskaite J, Kiudelis M. Umbilical hernia: factors indicative of recurrence. Medicina (Kaunas) 2008;44:855-9.
- Vohr BR, Rosenfield AG, Oh W. Umbilical hernia in the low-birth-weight infant (less than 1,500 gm). J Pediatr 1977;90:807-8.
- Blumberg NA. Infantile umbilical hernia. Surg Gynecol Obstet 1980;150:187-92.
- Morgan WW, White JJ, Stumbaugh S, Haller JA Jr. Prophylactic umbilical hernia repair in childhood to prevent adult incarceration. Surg Clin North Am 1970;50:839-45.
- Zendejas B, Kuchena A, Onkendi EO, Lohse CM, Moir CR, Ishitani MB et al. Fifty-three-year experience with pediatric umbilical hernia repairs. J Pediatr Surg 2011;46:2151-6.
- Scherer LR 3rd, Grosfeld JL. Inguinal hernia and umbilical anomalies. Pediatr Clin North Am 1993;40:1121-31.
- Turnage RH, Li BD, McDonald JC. Abdominal Wall, Umbilicus, Periton and Omentum. in: Sabiston Textbook of Surgery. edn. Edited by Towsend CM, Evers BM, Beauchamp RD, Mattox KL 2004:1171-97.
- Tank PW, Gest TR. The Abdomen. in: Lippincott Williams & Wilkins Atlas of Anatomy. 1 edn. Edited by Tank PW, Gest TR 2009:214-30.
- Lassaletta L, Fonkalsrud EW, Tovar JA, Dudgeon D, Asch MJ. The management of umbilicial hernias in infancy and childhood. J Pediatr Surg 1975;10:405-9.
- O’Donnell KA, Glick PL, Caty MG. Pediatric umbilical problems. Pediatr Clin North Am 1998; 45:791-9.
- Papagrigoriadis S, Browse DJ, Howard ER. Incarceration of umbilical hernias in children: a rare but important complication. Pediatr Surg Int 1998;14:231-2.
- Brown RA, Numanoglu A, Rode H. Complicated umbilical hernia in childhood. S Afr J Surg 2006;44:136-7.
- Martis JJ, Rajeshwara KV, Shridhar MK, Janardhanan D, Sudarshan S. Strangulated Richter’s Umbilical Hernia - A Case Report. Indian J Surg 2011;73:455-7.
- Chirdan LB, Uba AF, Kidmas AT. Incarcerated umbilical hernia in children. Eur J Pediatr Surg 2006;16:45-48.
- Fall I, Sanou A, Ngom G, Dieng M, Sankale AA, Ndoye M: Strangulated umbilical hernias in children. Pediatr Surg Int 2006; 22:233-5.
- Komlatse AN, Komla G, Komla A, Azanledji BM, Abossisso SK, Hubert T. Meckel’s diverticulum strangulated in an umbilical hernia. Afr J Paediatr Surg 2009;6:118-9.
- Okada T, Yoshida H, Iwai J, Matsunaga T, Ohtsuka Y, Kouchi K,et al. Strangulated umbilical hernia in a child: report of a case. Surg Today 2001;31:546-9.
- Sowula A, Groele H. (Treatment of incarcerated abdominal hernia). Wiad Lek 2003;56:40-4.
Öz
Objective: Umbilical hernia is a common anterior abdominal wall defect in childhood. Although the defect is present at birth, unlike other hernias of childhood, it may close spontaneously over time without the need for surgery. However, when these hernias do not close spontaneously, complications can develop that require emergency surgery. The aim of this study was to determine the incidence of spontaneous closure in patients diagnosed with umbilical hernia and the factors that influence this incidence, the complications that may develop during follow-up, the indications for surgery and the issues to consider when planning the follow-up of patients.
Material and Methods: Between January 2006 and December 2011, 1928 patients diagnosed with umbilical hernia and followed up and treated in our clinic were included in the study. In this retrospective cohort study the current size of umbilical hernia, comorbidities and demographic characteristics of the patients were analysed. Operative data, complications and postoperative follow-up of the operated patients were evaluated.
Results: The spontaneous closure rate of umbilical hernia was found to be 60%. The rate of spontaneous closure of umbilical hernia was higher in boys and the rate of operation was higher in girls. The risk of incarceration was higher in girls than in boys. The rate of spontaneous closure decreased with increasing defect size. It was found that comorbidities did not affect spontaneous closure of umbilical hernias. The rate of emergency surgery for incarceration was low (2%). Strangulation was noted in 1% of patients. All patients with incarceration were in Lassaletta group 2 (defect diameter 0.5-1.5 cm).
Conclusion: Conservative management is still the most accepted and safest method in the treatment of umbilical hernia. Incarceration and strangulation are very rare in umbilical hernias. Even if the umbilical hernia is complicated, surgical treatment is possible and peri- and post-operative complication rates are very low. Long-term morbidity and mortality due to incarceration have not been reported in the literature.
Anahtar Kelimeler
Kaynakça
- Weber TR. Umbilical and Other Abdominal Wall Hernias. In: Ashcraft’s Pediatric Surgery. 5 edn. Edited by Ashcraft KW, HolcombIII GW, Murphy JP: Elsevier 2005: 637-9.
- Malangoni MA, Gagliardi RJ. Hernias. in: Sabiston Textbook of Surgery. edn. Edited by Towsend CM, Evers BM, Beauchamp RD, Mattox KL 2004:1199-218.
- Başaklar AC. Göbek ve Karın Ön Duvarı Anomalileri. in: Bebek ve Çocukların Cerrahi ve Ürolojik Hastalıkları edn. Edited by Başaklar AC. Ankara: Palme 2006:1051-81.
- Beres A, Christison-Lagay ER, Romao RL, Langer JC. Evaluation of Surgisis for patch repair of abdominal wall defects in children. J Pediatr Surg 2012;47:917-9.
- Venclauskas L, Silanskaite J, Kiudelis M. Umbilical hernia: factors indicative of recurrence. Medicina (Kaunas) 2008;44:855-9.
- Vohr BR, Rosenfield AG, Oh W. Umbilical hernia in the low-birth-weight infant (less than 1,500 gm). J Pediatr 1977;90:807-8.
- Blumberg NA. Infantile umbilical hernia. Surg Gynecol Obstet 1980;150:187-92.
- Morgan WW, White JJ, Stumbaugh S, Haller JA Jr. Prophylactic umbilical hernia repair in childhood to prevent adult incarceration. Surg Clin North Am 1970;50:839-45.
- Zendejas B, Kuchena A, Onkendi EO, Lohse CM, Moir CR, Ishitani MB et al. Fifty-three-year experience with pediatric umbilical hernia repairs. J Pediatr Surg 2011;46:2151-6.
- Scherer LR 3rd, Grosfeld JL. Inguinal hernia and umbilical anomalies. Pediatr Clin North Am 1993;40:1121-31.
- Turnage RH, Li BD, McDonald JC. Abdominal Wall, Umbilicus, Periton and Omentum. in: Sabiston Textbook of Surgery. edn. Edited by Towsend CM, Evers BM, Beauchamp RD, Mattox KL 2004:1171-97.
- Tank PW, Gest TR. The Abdomen. in: Lippincott Williams & Wilkins Atlas of Anatomy. 1 edn. Edited by Tank PW, Gest TR 2009:214-30.
- Lassaletta L, Fonkalsrud EW, Tovar JA, Dudgeon D, Asch MJ. The management of umbilicial hernias in infancy and childhood. J Pediatr Surg 1975;10:405-9.
- O’Donnell KA, Glick PL, Caty MG. Pediatric umbilical problems. Pediatr Clin North Am 1998; 45:791-9.
- Papagrigoriadis S, Browse DJ, Howard ER. Incarceration of umbilical hernias in children: a rare but important complication. Pediatr Surg Int 1998;14:231-2.
- Brown RA, Numanoglu A, Rode H. Complicated umbilical hernia in childhood. S Afr J Surg 2006;44:136-7.
- Martis JJ, Rajeshwara KV, Shridhar MK, Janardhanan D, Sudarshan S. Strangulated Richter’s Umbilical Hernia - A Case Report. Indian J Surg 2011;73:455-7.
- Chirdan LB, Uba AF, Kidmas AT. Incarcerated umbilical hernia in children. Eur J Pediatr Surg 2006;16:45-48.
- Fall I, Sanou A, Ngom G, Dieng M, Sankale AA, Ndoye M: Strangulated umbilical hernias in children. Pediatr Surg Int 2006; 22:233-5.
- Komlatse AN, Komla G, Komla A, Azanledji BM, Abossisso SK, Hubert T. Meckel’s diverticulum strangulated in an umbilical hernia. Afr J Paediatr Surg 2009;6:118-9.
- Okada T, Yoshida H, Iwai J, Matsunaga T, Ohtsuka Y, Kouchi K,et al. Strangulated umbilical hernia in a child: report of a case. Surg Today 2001;31:546-9.
- Sowula A, Groele H. (Treatment of incarcerated abdominal hernia). Wiad Lek 2003;56:40-4.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Klinik Tıp Bilimleri (Diğer) |
| Bölüm | ORIGINAL ARTICLES |
| Yazarlar | |
| Erken Görünüm Tarihi | 12 Şubat 2024 |
| Yayımlanma Tarihi | 13 Mayıs 2024 |
| Gönderilme Tarihi | 13 Eylül 2023 |
| Yayımlandığı Sayı | Yıl 2024 Cilt: 18 Sayı: 3 |
