KIRURŠKO LIJEČENJE PREPONSKE KILE: AMBULANTNO ILI BOLNIČKI

Anko Antabak, Ivana Bešlić, Krešimir Bulić, Mate Škegro, Dino Papeš, Miram Pasini, Marko Bogović, Stanko Ćavar, Tomislav Luetić

Hernioplastika preponske kile kirurški je zahvat koji se može izvoditi u bolnici ili dnevnoj bolnici. Odabir ­bolesnika u jedan od ova dva načina liječenja nije jednostavan. Postoji više kriterija probira, no ponajprije se misli na ­sigurnost bolesnika. Ovaj rad analizira kriterije odabira te uspoređuje sigurnost bolesnika s pojavnošću komplikacija nakon operacije dviju skupina bolesnika (ukupno 590) kojima je načinjena hernioplastika preponske kile tijekom 2015. godine u KBC-u Zagreb. U prvoj je 226 (38,3%) pacijenata operiranih u dnevnoj bolnici, a u drugoj njih 364 (61,7%) bolnički liječena (69 hitno i 295 elektivno). Većina bolesnika dječje dobi (0 – 18 godina) operirana je bolnički. Bolesnici dobnih skupina 19 – 34 i 35 – 49 godina golemom su većinom operirani u jednodnevnoj kirurgiji, a stariji od 74 godine u bolničkim uvjetima. Bolesnici jednodnevne kirurgije bili su statusa ASA I ili II (samo troje bolesnika ASA III). Većina bolnički ­operiranih bolesnika bila je statusa ASA II (52,2%). ASA I bilo je 24%, ASA III 21%, a ASA IV 3% bolesnika. Lokalna anestezija bila je dominantan izbor kod pacijenata dnevne bolnice (68%), a u bolnički liječene skupine rijetko (8%). Učestalost poslijeoperacijske infekcije (2%) i boli (8%) bila je vrlo niska u obje skupine, a razlika između njih nije statistički značajna. Hematomi i seromi pojavljivali su se jednakim obrascem: vrlo rijetko i bez razlika između skupina. Recidiv se s neznatnom razlikom nešto češće pojavljivao u skupini pacijenata višednevne kirurgije. Od ukupno 226 bolesnika dnevne bolnice njih sedmero (3,0%) primljeno je na bolničko liječenje. Troje zbog mučnine, slabosti i hipotenzije, dvoje bolesnika zbog tahikardije i stenokardije, jedan zbog neurastenije, jedan zbog skrotalnog hematoma. Podjednako malen broj ranih komplikacija, recidiva i neplaniranih produžetaka liječenja bolesnika dnevne bolnice govori da su obje skupine liječene na siguran način, a probir bolesnika bio je primjeren.

Inguinal hernia repair is a surgical procedure that can be done in inpatient or one-day surgery. Adequate patient selection is not a simple task. There are more than several selection criteria, but the main objective is a patient safety. This study analyzes the patient selection criteria and compares safety in the manner of postoperative complications between the two groups of patients. There were 590 patients who underwent surgical repair of inguinal hernia at the University Hospital Centre Zagreb in 2015. 226 (38.3%) of them were treated in one-day surgery, and 364 (61.7%) were treated at the main Surgical department; 69 of those had an emergent presentation. Most patients of child age (0–18) were treated at the inpatient department. ­Patients in the age groups between 19 and 39 years, as well as those between 35 and 49 were dominantly managed at the Department of one-day surgery. Those patients were mainly ASA I and ASA II (only three of them were ASA III), while hospitalized patients were mostly ASA II (52.2%). In the hospitalized, inpatient group, frequency of ASA I was 24%, ASA II 21% and ASA IV 3%. The greatest number of one-day surgery patients underwent surgery under local anesthesia (68%). In contrast, only 8% of the inpatient group had a surgery under local anesthesia. The percentage of patients with post­operative wound infection was 2%, and the incidence of pain after surgery was 8%. The results didn’t statistically differ between the groups. The recurrence rate was slightly more frequent in the inpatient group. Hematomas and seromas had the same incidence pattern; they were rarely present and without differences between the groups. 7 of 226 ambulatory patients (3%) were hospitalized. The main causes for three of them were nausea, weakness and hypotension; two patients had tachycardia and stenocardia, one patient had neurasthenia, and also one had scrotal hematoma. The hernia repair in both groups was associated with low postoperative complications, low recurrence rate, and low percentage of unplanned hospital ­admissions. Therefore it is considered that both groups were treated in a safe manner and patient selection was adequate.