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Kugel Fıtık Tamiri Gerçekten Minimal İnvaziv midir?: Prospektif Randomize Bir Çalışma

Is Kugel Herniorraphy Really Minimally Invasive?: A Prospective, Randomized Study

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Abstract (2. Language): 
Background: Kugel herniorraphy had been advocated as a minimally invasive technique. The purpose of this study was to compare inflammatory responses and clinical outcomes after Kugel and Lichtenstein procedures. Patients and methods: Thirty patients with unilateral inguinal hernia were randomized into Kugel and Lichtenstein repair groups. Peripheral venous blood samples were collected, to measure the levels of interleukin-6 and C-reactive protein, just prior to surgery and then 12 and 48 hours postoperatively. Postoperative acute and chronic pains were evaluated. Time to return normal activities and work was recorded. Results: Interleukin-6 levels significantly increased after Lichtenstein procedure. C-reactive protein levels were significantly increased in both groups. Patients had less postoperative pain and they recovered earlier after the Kugel procedure. Conclusions:In conclusion our data show that Kugel herniorraphy causes less inflammatory response, less postoperative acute pain and rapid recovery compared with Lichtenstein technique.
Abstract (Original Language): 
Amaç: Kugel fıtık tamirinin minimal invaziv bir teknik olduğu ileri sürülmektedir. Bu çalışmanın amacı Kugel ve Lichtenstein girişimlerinden sonra gelişen enflamatuvar yanıtları ve klinik sonuçları karşılaştırmaktı. Hastalar ve Metotlar: Tek taraflı kasık fıtığı olan 30 hasta Kugel ve Lichtenstein tamir gruplarına rastgele ayrıldılar. Cerrahi girişimden hemen önce ve girişimden sonraki 12. ve 48. saatlerde, interlökin-6 ve C-reaktif protein seviyelerini ölçmek için periferik venöz kan örnekleri alındı. Cerrahi sonrası akut ve kronik ağrı değerlendirildi. Normal aktivitelere ve işe dönüş süreleri kaydedildi. Bulgular: Lichtenstein girişiminden sonra interlökin-6 düzeyleri belirgin olarak artarken Kugel fıtık tamiri, interlökin-6 düzeylerinde anlamlı olmayan bir artışa neden oldu. C-reaktif protein düzeyleri her iki grupta da belirgin olarak arttı. Kugel girişiminden sonra hastaların ağrısı daha azdı ve daha erken iyileştiler. Sonuç: Sonuçlarımız göstermektedir ki, Kugel fıtık tamiri Lichtenstein tekniği ile karşılaştırıldığında daha az enflamatuvar yanıta, daha az ameliyat sonrası ağrıya ve daha hızlı iyileşmeye neden olmaktadır.
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REFERENCES

References: 

1. Amid PK, Shulman AG, Lichtenstein IL. A critical evaluation of the Lichtenstein
tension-free hernioplasty. Int Surg, 1994; 79: 76-9.
2. Amid PK, Shulman AG, Lichtenstein IL. Open tension-free repair of inguinal
hernias: the Lichtenstein technique. Eur J Surg, 1996; 162: 447-53.
3. Friis E, Lindahl F. The tension-free hernioplasty in a randomized trial. Am J Surg,
1996; 172: 315-9.
4. Kugel RD. Minimally invasive, nonlaparoscopic, preperitoneal, and sutureless,
inguinal herniorrhaphy. Am J Surg, 1999; 178: 298-302.
5. Baigrie RJ, Lamont PM, Kwiatkowski D, et al. Systemic cytokine response after major
surgery. Br J Surg, 1992; 79: 757-60.
6. Biffl WL, Moore EE, Moore FA, Peterson VM. Interleukin-6 in the injured patient:
marker of injury or mediator of inflammation. Ann Surg, 1996; 224: 647-64.
7. Gebhard F, Pfetsch H, Steinbach G, et al. Is interleukin 6 an early marker of injury
severity following major trauma in humans? Arch Surg, 2000; 135: 291-5.
8. Rutkow IM, Robbins AW. Tension-free inguinal herniorraphy: A preliminary report
on the mesh plug technique. Surgery, 1993; 114: 3-8.
9. Gilbert AI. An anatomic and functional classification for the diagnosis and treatment
of inguinal hernia. Am J Surg, 1989; 157: 331-3.
10. Bay-Nielsen M, Perkins FM, Kehlet H. Pain and functional impairment 1 year after
inguinal herniorrhaphy: a nationwide questionnaire study. Ann Surg, 2001; 233: 1–7.
11. Hauser CJ, Zhou X, Joshi P, Cuchens MA, Kregor P, Devidas M, Kennedy RJ, Poole
GV, Hughes JL. The immune microenvironment of human fracture/soft-tissue
hematomas and its relationship to systemic immunity. J Trauma 1997;42:895-903.
12. Dziedzic T, Bartus S, Klimkowicz A, Motyl M, Slowik A, Szczudlik A. Intracerebral
hemorrhage triggers Interleukin-6 and Interleukin-10 release in blood. Stroke
2002;33:2334-5.
13. Stadnyk AW, Gauldie J. The acute phase protein response during parasitic infection.
Immunol Today, 1991; 12: 7-12.
14. Di Vita G, Milano S, Frazetta M, et al. Tension-free hernia repair is associated with an
increase in inflammatory response markers against the mesh. Am J Surg, 2000;
180:203-7.
15. Fenoglio ME, Bermas HR, Haun WE, Moore JT. Inguinal hernia repair: results using
an open preperitoneal approach. Hernia, 2005; 9: 160-1.
16. Reddy KM, Humphreys W, Chew A, Toouli J. Inguinal hernia repair with the Kugel
patch. ANZ J Surg, 2005; 75: 43-7.
17. Baroody M, Bansal V, Maish G. The open preperitoneal approach to recurrent
inguinal hernias in high-risk patients. Hernia, 2004; 8: 373-5.
18. Schroder DM, Lloyd LR, Boccaccio JE, Wesen CA. Inguinal hernia recurrence
following preperitoneal Kugel patch repair. Am Surg, 2004; 70: 132–6.
19. Nordin P, Bartelmess P, Jansson C, et al. Randomized trial of Lichtenstein versus
Shouldice hernia repair in general surgical practice. Br J Surg, 2002; 89: 45-9.
20. Köninger J, Redecke J, Butters M. Chronic pain after hernia repair: a randomized trial
comparing Shouldice, Lichtenstein and TAPP. Langenbecks Arch Surg, 2004; 389:
361-5.
21. Crozier TA, Muller JE, Quittkat D, et al. Effect of anaesthesia on the cytokine
response to abdominal surgery. Br J Anaesthes, 1994; 72: 280-5.
22. Schwab R, Eissele S, Brückner UB, Gebhard F, Becker HP. Systemic inflammatory
response after endoscopic (TEP) vs Shouldice groin hernia repair. Hernia 2004; 8:
226-32.

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