Postoperativne ventralne hernije nakon operacije aneurizme abdominalne aorte

master's thesis

• Title (english): Postoperative ventral hernias after abdominal aortic aneurysm surgery
• Author: Arijan Matej Marinović
• Mentor: Ivo Lovričević (mentor)
• Committee member: Dujo Kovačević (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Ivo Lovričević (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2016-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Postoperativne ventralne hernije su česta komplikacija nakon medijalne laparotomije. Nakon operacije AAA je dobro dokumentirana veća učestalost ventralnih hernija u odnosu na ostale operacije u abdomenu koje dijele sličan kirurški pristup. Predloženo je više zajedničkih faktora koji mogu biti u podlozi ovog procesa. Ti faktori mogu biti biološki, vezani uz pacijenta u kraćem postoperativnom periodu ili se prikazuju kroz duži period nakon operacije. Faktori poput; operacijske tehnike, načina šivanja i perioperativnih komplikacija su također izrazito važni u kasnijoj prognozi i mogućnosti razvoja hernije. Od faktora vezanih uz pacijenta literatura i klinička zapažanja govore u prilog važnosti postojećih bolesti vezivnoga tkiva, poremećaja sinteze kolagena, kroničnim bolestima, pušenju i genetskoj podlozi kao važnima u zajedničkoj etiopatogenezi. U kirurškom pristupu treba definitivno uzeti u obzir medijalnu laparotomiju kao faktor koji po nekim studijama povećava rizik za razvoj hernije gotovo 3 puta, vrstu šavova koji se koriste te produženo krvarenje za vrijeme operacije ili infekciju te brojne druge. Cilj ovoga rada je bio utvrditi postoji li povećana učestalost razvoja ventralnih hernija nakon operacije aneurizme abdominalne aorte i pronaći zajedničke faktore rizika koji povezuju ova dva klinička entiteta. Analizirane su povijesti bolesti 82 pacijenta s operacijom AAA, 227 pacijenta sa operacijom ventralne hernije i 47 pacijenata s operacijom rupturirane AAA od 2011 do 2015 godine. U 6 (7.3%) pacijenata koji su podvrgnuti operaciji AAA je nađena postoperativna ventralna hernija. Svi pacijenti s AAA koji su poslije razvili ventralnu herniju su operirani medijalnom laparotomijom a sanacija hernije je obavljena hernioplastikom s meshom. Od ostalih faktora rizika, dio pacijenata je imao dijabetes mellitus tip 2, dio je na terapiji ACE inhibitorima zbog dugogodišnje hipertenzije, jedan u povijesti bolesti ima operaciju poplitealne arterije a jedan je imao i ingvinalnu herniju. Učestalost postoperativne ventralne hernije kod pacijenata s operacijom AAA i zajedničke faktore rizika koje ti pacijenti imaju bi trebalo dodatno istražiti kako bi se dobio statistički značajniji uzorak. Tada bi se moglo bolje razumjeti nastanak i mogućnosti u sprječavanju ove komplikacije.

Abstract (english)

Postoperative ventral hernias are a common complication after medial laparotomy. A higher incidence of postoperative ventral hernias has been well documented after AAA surgery compared to other abdominal operations with similar surgical approaches. Several risk factors have been proposed as a base of this process. These factors can be biological, patient related, in a shorter post-operative period or can manifest in a longer time after the surgery. Factors like; surgical technique, stitching methods and perioperative complications are highly important in long term prognosis and hernia creation possibility. Studies and clinical observations regarding patient related factors emphasise relevance of connective tissue related disease, collagen synthesis disorders, chronic disease, smoking and genetic foundations as common ethiopathogenical processes. Medial laparotomy is a definitive factor in surgical approach that, according to some studies increase risk of postoperative ventral hernias up to 3 fold. Other surgical factors like types of stitches used, prolonged operative bleeding or infection and many others are also considered to be related with higher incidence. Aim of this study was to determine if there was a higher incidence of postoperative ventral hernias in patients that underwent abdominal aortic aneurysm repair and to find common risk factors that bind these two clinical entities. I have analysed medical records of 82 patients that underwent AAA repair, 227 patients with ventral hernia operations and 47 patients surgically treated with rupture of AAA in a time period from 2011 to 2015. I have found 6 (7.3%) patients that have developed postoperative ventral hernia after AAA repair. All of the patients that underwent AAA repair and have developed ventral hernia have been operated on by medial laparotomy approach, and hernia repair has been done with mesh hernioplasty procedure. Other risk factors that analysed patients had, were; a portion of patients had diabetes mellitus type 2, a portion had ACE inhibitors therapy for long term hypertension, one patient’s medical records revealed popliteal artery operation and another had inguinal hernia. Incidence and related risk factors for postoperative ventral hernias after AAA should be examined further in order to obtain a more statistically relevant sample. In that case we could better understand its genesis and our ability to stop this complication.

• Keywords: postoperativna ventralna hernija; aneurizma abdominalne aorte; AAA; komplikacija; faktori rizika
• Keywords (english): postoperative ventral hernia; aortic abdominal aneurysm; AAA; complication; risk factors
• Language: croatian
• URN:NBN: urn:nbn:hr:105:323515
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2017-07-14 07:16:33