Kirurško liječenje preponskih hernija

master's thesis

• Title (english): Surgical treatment of groin hernia
• Author: Andrej Dubić
• Mentor: Marko Sever (mentor)
• Committee member: Žarko Rašić (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Marko Sever (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2023-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Preponska hernija ili kila je najčešća abdominalna hernija. Operacija preponske hernije je najčešće izvođena operacija opće i abdominalne kirurgije. Dijelimo ih na ingvinalne i femoralne. Ingvinalne hernije su češće i zastupljenije u muškaraca, dok je u žena češća učestalost femoralnih. Ingvinalne hernije dijelimo na direktne (medijalne) i indirektne (lateralne). Indirektne su učestalije i one mogu biti kongenitalne ili stečene, dok su direktne uvijek stečene. U kliničkoj slici preponskih hernija vidljiva je oteklina u preponi te je nazastupljeniji simptom bol ili nelagoda. Međutim, hernija se može ukliještiti te se pri tome javljaju simptomi mehaničkog ileusa. Za postavljanje dijagnoze su dovoljni anamneza i klinički pregled. U slučajevima gdje postoje nedoumice i kako bi se suzila diferencijalna dijagnoza koja je vrlo široka, na raspolaganju su radiološke slikovne metode. Kod simptomatskih ingvinalnih hernija koje nisu strangulirane može se izvesti manualna repozicija kako bi se odgodila operacija. Ali jedini trajni oblik liječenja je kirurško liječenje koje je indicirano u svim preponskim hernijama osim asimpomatskih ingvinalnih koje se samo prate. Princip kirurškog liječenja preponske hernije se svodi na zbrinjavanje kilne vreće te kilnog otvora hernioplastikom. Operacije se provode otvorenim te minimalno invazivnim metodama odnosno laparoskopskim i robotski asistiranim hernioplastikama. Otvorene se dijele na one bez mrežica i s mrežicom. Danas je najzastupljenija metoda zbrinjavanja preponskih hernija tehnika po Lichtensteinu koja pripada otvorenim hernioplastikama bez mrežice. Međutim, nove preporuke sugeriraju da je laparoskopsko liječenje zlatni standard. Studije pokazuju da je ono povezano s bržim oporavkom, smanjenom postoperativnom boli i sličnim stopama recidiva u usporedbi s otvorenom hernioplastikom. Ali ako kirurg nema dovoljno iskustva s laparoskopskim načinom liječenja jer je krivulja učenja puno duža, otvorene operacije su preporučene. Robotska kirurgija preponskih hernija trenutno ne pokazuje prednosti u usporedi s laparoskopijom te je to područuje još uvijek potrebno unaprijeđivati.

Abstract (english)

An inguinal hernia is the most common abdominal hernia. Inguinal hernia surgery is the most performed general and abdominal surgery. We divide them into inguinal and femoral. Inguinal hernias are more common and prevalent in men, while femoral hernias are more common in women. Inguinal hernias are divided into direct (medial) and indirect (lateral). Indirect ones are more common and they can be congenital or acquired, while direct ones are always acquired. In the clinical presentation of inguinal hernias, swelling in the groin is visible and the most common symptom is pain or discomfort. However, the hernia can be incarcerated and the symptoms of bowel obstruction can appear. Anamnesis and a clinical examination are sufficient to make a diagnosis. In cases where there are doubts and to narrow down the differential diagnosis, which is very broad, radiological imaging methods are available. In symptomatic inguinal hernias that are not strangulated, manual reduction can be performed to delay surgery. But the only permanent form of treatment is surgical treatment, which is indicated in all inguinal hernias except for asymptomatic inguinal hernias that are only monitored. The principle of surgical treatment of inguinal hernia boils down to treating the hernial sac and the hernial neck with hernioplasty. Operations are performed using open repair and minimally invasive methods, i.e. laparoscopic and robot-assisted hernioplasty. Open repairs are divided into open primary tissue approximation nonmesh and open tension- free repairs. Today, the most common method of treating inguinal hernias is the Lichtenstein technique, which belongs to open tension- free repairs. However, new recommendations suggest that laparoscopic treatment is the gold standard. Studies show that it is associated with faster recovery, reduced postoperative pain, and similar recurrence rates compared to open hernioplasty. But if the surgeon does not have enough experience with the laparoscopic method of treatment because the learning curve is much longer, open repairs are recommended. Robotic surgery of inguinal hernias currently does not show advantages in comparison with laparoscopy, and this suggests that it still needs to be improved.

• Keywords: preponska hernija; hernioplastika; laparoskopska kirurgija
• Keywords (english): groin hernia; hernioplasty; laparoscopic surgery
• Language: croatian
• URN:NBN: urn:nbn:hr:105:714750
• 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: 2023-10-24 09:30:49