članak: 1 od 1  
Acta chirurgica iugoslavica
2003, vol. 50, br. 2, str. 37-48
jezik rada: srpski
stručni članak
doi:10.2298/ACI0302037Z

Rivesova tehnika (direktan ingvinalni pristup) u rešavanju velikih ingvinoskrotalnoh i recidivantnih kila
Univerzitet u Beogradu, Medicinski fakultet, Klinički centar Srbije

Sažetak

Hirurzi danas imaju na raspolaganju mnogo varijacija različitih operativnih procedura u rešavanju ingvinalnih kila (tenzione ili beztenzione tehnike). One se izvode kroz otvoreni ili endoskopski pristup. Klasične tenzione tehnike predstavljaju operacije izbora za manje indirektne, direktne ili femoralne kile kod mlađih bolesnika, dok su beztenzione tehnike najbolje rešenje za sve vrste preponskih kila kod starijih bolesnika sa velikom destrukcijom transverzalne fascije i kod većine recidivantnih kila. Pozicioniranje mrežica kod beztenzionih tehnika može biti na različitim nivoima. Kod velikih ingvinalnih kila, gde je uništen najveći deo transverzalne fascije miopektinalnog orificijuma, anatomski je najsvrsishodnije pozicioniranje mrežice u preperitonealni prostor. Rivesova tehnika zasniva se na ovom konceptu i predstavlja jedno od dobrih rešenja u ovakvim situacijama. U periodu januar 2001 decembar 2002. autori su različitim operativnim tehnikama rešili 99 preponske kile, od čega 78 primarne i 21 recidivantne. Rivesova tehnika primenjena je u 46 slučaja (46.5%), i to kod 26 primarnih ingvinoskrotalnih kila (3 IIIA, 22 IIIB, 1 IIICstadijuma po Nyhusovoj klasifikaciji) i kod 20 recidivantnih kila (6 IVA, 11 IVB, 3 IVD). Komplikacije nakon Rivesove tehnike bile su: 1(2.17%) recidiv, 1(2,17%) ishemični orhitis i 1(2,17%) hematom skrotuma. Infekcije i hroničnog bola nije bilo a bolesnici su praćeni od 30 dana do 2 godine. Autori su pokazali da Rivesova tehnika predstavlja sigurno rešenje za primarne indirektne, direktne i femoralne kile sa velikim kilnim defektom (pogotovo za velike, tzv. "džinovske" ingvinoskrotalne kile) i za sve vrste recidivantnih kila. Prednost ove tehnike je njeno lako izvodjenje bez nekog prethodnog specijalnog treninga, zbog činjenice da je disekcija i preparacije ista kao kod tenzionih tehnika. Sa malom količinom protetskog materijala zatvaraju se sva slaba mesta miopektinealnog orificijuma. Realni rizici ove tehnike su ishemični orhitis i hronična neuralgija kod tretmana recidiva, kao i prisustvo polipropilenske mrežice u Bogrosovom prostoru.

Ključne reči

Rivesova tehnika; ingvinoskrotalna kila; recidivantna igvinalna kila

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