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Çocuk Kas›k F›t›klar› Genel Cerrah Taraf›ndan Ameliyat Edilmeli Midir?

ABSTRACT Amaç: Ükemizde çocuk kas›k f›t›klar› (KF) çocuk cerrahlar›, genel cerrahlar ve ürologlar taraf›ndan ameliyat edilmektedir. Çocuk kas›k f›t›k- lar›n›n ameliyat sonuçlar› üzerine uzmanl›k alan›n›n etkilerini ortaya koyan çok az say›da çal›flma vard›r. Çal›flmam›z›n amac› "çocuk kas›k f›t›klar› genel cerrahlar taraf›ndan yap›lmal› m›d›r" sorusuna cevap aramak ve bilimsel bir ortamda tart›flmakt›r. Gereç ve Yöntem: Kliniimizde Aral›k 2005 ve Mart 2007 tarihleri aras›nda KF nedeni ile ameliyat edilen, yafllar› iki ile 13 aras›nda deiflen, top- lam 26 olgu; yafl, cinsiyet, f›t›k olan taraf, inkarserasyon olup olmamas› ve komplikasyon varl›¤› aç›s›ndan geriye dönük olarak incelendi. Bulgular: Ortalama yafllar› 6.6 y›l olan 26 olgunun %73'ü erkek (n=19), %27'si k›z (7) olup, olgular›n tamam›nda indirekt KF vard›. Olgular›n beflinde sol tarafta, 21'inde satarafta KF tespit edildi. Sol tarafta KF olan befl olgudan sadece birinde, satarafta KF olan 21 olgudan alt›- s›nda inkarserasyon tespit edildi. Tedavi olarak Nyhus tip 1 KF bulunan olgular›n 21'ne yüksek ligasyon (YL) uygulan›rken Nyhus tip 2 KF bulunan befl olguda internal ring daralt›ld› (Marcy onar›m›). Toplam sekiz olguda ek patoloji saptand›. Üç olguya testis torsiyonu ve inme- mifl atrofik testis nedeniyle orfliektomi, kese içinde akut apandisit saptanan bir olguya (Amyand f›t›¤›) apendektomi, iki olguya hidrosel ne- deniyle hidroselektomi, bir olguya parsiyel omentektomi ve bir olguya da umblikal herni tamiri uyguland›. Hastalar›n hiçbirinde kompli- kasyon geliflmedi. Ek patolojisi bulunan olgular postoperatif dönemde ortalama üçüncü günde taburcu edilirken, dierleri birinci günde ta- burcu edildi. Olgular›n alt› ayl›k takiplerinde herhangi bir problem ile karfl›lafl›lmad›. Sonuç: Ülkemizin içinde bulunduu sal›k hizmetleri flartlar› da göz önünde bulundurularak acil vakalarda olduu gibi; çocuk cerrah› olma- yan ya da çocuk cerrah›na ulafl›m›n güç olduu bölgelerde; çocuk kas›k f›t›klar›ndaki yüksek inkarserasyon insidans›, artm›fl morbidite ve mortalite riskinden dolay›, genel cerrahlar taraf›ndan elektif kas›k f›t›¤› ameliyatlar› da yap›lmal›d›r. Anahtar kelimeler: Çocuk kas›k f›t›¤›, çocuk cerrah›, genel cerrah, tedavi ABSTRACT Should pediatric inguinal hernia be operated by general surgeon? Objective: Pediatric inguinal hernia is treated by both pediatric and general surgeons as well as urologic surgeons. There have been few studies documenting the effect of subspecialty training on outcomes after hernia operation in children. The aim of this study is to look for an answer to the question of "should pediatric inguinal hernia be operated by general surgeon'' and discuss in a scientific field. Material and Methods: Twenty six children (age 2-13) with inguinal hernia were operated between December 2005 and March 2007. Patients were evaluated retrospectively regarding age, gender, localisation of hernias, presence of incarceration and complication. Results: Mean age of the patients' was 6.6 with a male to female ratio of 19/7. All of them had indirect inguinal hernias with 5 case having left sided and remaining 21 cases having right sided inguinal hernia. One case in left sided and 6 cases with right sided hernia had incarceration. High ligation was performed to 21 cases with Nyhus type 1 hernia and Marcy repair was performed to the remaining 5 cases with Nyhus type 2 hernias. Eight of the patients had additional pathologies as 3 undescended testis, one Amyand's hernia, two hydrocele, one omental incarceration and one umbilical hernia. No morbidity occurred in any of the patients with mean hospital stay as 3 and 1 day in patients with additional pathologies and mere inguinal hernias respectively. Follow up period of six months was uneventful in all patients. Conclusion: Regarding the socio-economical conditions in our country, as in emergency surgery, elective pediatric inguinal hernia should be performed by general surgeons in localisations without pediatric surgeons due to increased risk of incarceration and morbidity and mortality rates.

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