Incarcerated inguinal hernias surgical treatment specifics in elderly patients

Abstract

Background/Aim. Incarcerated inguinal hernias surgical treatment represents one of the most frequent surgical treatments in elderly patients. The percentage of incarcerated inguinal hernias urgent surgical treatments is growing exponentially with the age in patients over 50. The aim of the study was to investigate some of the factors that may have impact on the incarcerated inguinal hernias surgical treatment outcome in elderly patients. Methods. The study included 180 patients classified in two groups: the study group (> 65 years of age) and the control group (? 65), managed in the period from January 2005 till March 2009 at the General Surgery Clinic, Clinical Center Nis. Results. Most of the patients had right inguinal hernia (52.6%, the study group; 59.1%, the control group). All the study group patients suffered from some of accompanying chronic diseases (100%), opposite to 39 (59%) patients of the control group. Synthetic material was implanted in 124 (68.9%) patients, while the tension technique was performed in 65 (31.1%) patients. The duration of incarceration more than 24 h (p = 0.015), previous abdominal surgery (p = 0.001), the American Society of Anesthesiologists physical status classification system (ASA classification) (p = 0.033) and the presence of chronic diseases (p = 0.01) appeared to be statistically significant risk factors for performing intestinal resection in the study group, while in the control group they represented risk factors, but not at the level of statistical significance (p <0.05), except for the duration of incarceration (p = 0.007). A higher ASA stage (p = 0.001) and the presence of bowel resection (p <0.001) are the most important risk factors for lethal outcome in both groups of patients. Conclusion. Incarcerated inguinal hernia in elderly patients is a serious problem. A higher ASA score and the presence of bowel resection are the most important factors related to unfavorable outcome.Uvod/Cilj. Hirursko resavanje ukljestenih ingvinalnih kila predstavlja jednu od najcescih hirurskih intervencija kod starijih osoba. Procenat urgentno hirurski resenih ukljestenih ingvinalnih kila eksponencijalno raste sa godinama starosti kod osoba starijih od 50 godina. Cilj ove studije bio je ispitivanje nekih od faktora koji mogu uticati na ishod hirurskog lecenja ukljestenih ingvinalnih kila kod starijih osoba. Metode. Studija je obuhvatala 180 bolesnika, razvrstanih u dve grupe: ispitivana (> 65 god) i kontrolna grupa (? 65 god), zbrinutih u periodu od januara 2005. do marta 2009. u Klinici za opstu hirurgiju Klinickog centra Nis. Rezultati. Najveci broj bolesnika imao je desnu ingvinalnu kilu (52,6% u ispitivanoj, 59,1% u kontrolnoj grupi). Svi bolesnici ispitivane grupe (100%), imali su neko od pratecih hronicnih oboljenja, nasuprot 39 (59%) bolesnika u kontrolnoj grupi. Sintetski materijal bio je ugradjen kod 124 (68,9%) bolesnika, dok je tenzionom tehnikom bilo zbrinuto 65 (31,1%) bolesnika. Duzina ukljestenja preko 24h (p = 0,015), prethodne abdominalne operacije (p = 0,001), The American Society of Anesthesiologists - klasifikacioni sistem fizhickog stanja (ASA klasifikacija) (p = 0,033) i prisustvo hronicnih oboljenja (p = 0.01) izdvojili su se kao statisticki znacajni faktori rizika od izvodjenja crevnih resekcija u ispitivanoj grupi, dok su u kontrolnoj grupi predstavljali faktore rizika bez statisticke znacajnosti (p < 0.05), izuzev duzine ukljestenja (p = 0.007). Visi ASA stadijum (p = 0.001) i prisustvo resekcije creva (p < 0.001), bili su najznacajniji faktori rizika od letalnog ishoda bolesnika u obe ispitivane grupe. Zakljucak. Ukljestena ingvinalna kila kod starijih bolesnika ozbiljan je problem. Visi ASA skor, kao i postojanje crevne resekcije predstavljali su najvaznije faktore rizika od nezeljenog ishoda.