| Abstract | Cilj istraživanja: Usporediti upalni odgovor organizma na operacijsku noksu između laparoskopski asistiranog perkutanog zatvaranja unutarnjeg preponskog kanala (PIRS) i otvorene modificirane Marcy tehnike u liječenju preponske kile u djece.
Ispitanici i metode: Od svibnja 2017. do travnja 2018. ukupno 32 djece, srednje dobi od 4,5 godine, s jednostranom preponskom kilom, uključeno je u randomizirano prospektivno istraživanje. Ispitanici su podijeljeni u dvije skupine, koristeći program randomizacije, s obzirom na operacijsku tehniku. Iz venske krvi ispitivani su upalni parametri: leukociti, C-reaktivni protein (CRP), interleukin-6 (IL-6) i tumor nekrotizirajući faktor alfa (TNF-α), koji su mjereni u tri vremenske točke.
Rezultati: Definiran je statistički značajan porast koncentracije svih mjerenih upalnih parametara kroz ispitivano vrijeme (P<0,001). Nadalje, pokazano je kako vrsta kirurškog zahvata značajno utječe na razine leukocita, CRP-a i IL-6 i to na način da se korištenjem modificirane Marcy metode stvara jača upalna reakcija (leukociti 11,4 ± 3,1× 109/L; CRP 11,5 mg/L; IL-6 11,0 pg/mL) nego pri korištenju PIRS tehnike (leukociti 7,6 ± 1,6×109/L; CRP 0,8 mg/L; IL-6 2,0 pg/mL) (P<0,001). Sličan uzorak vrijedi i za TNF-α (Marcy 16,8 pg/mL; PIRS 10,1 pg/mL), ali je korelacija između vrste operacijskog zahvata i koncentracije TNF-α bila značajna tek pri razini od 0,1 (P=0,055). Prosjek trajanja operacijskog zahvata bio je značajno kraći (9 ± 2 min) u PIRS skupini u odnosu na Marcy skupinu (25 ± 7 min) (P<0,001). Značajno niža razina boli zabilježena je u PIRS skupini (VAS=2) u usporedbi s Marcy skupinom (VAS=6) (P<0,001).
Zaključci: Korištenje laparoskopske PIRS tehnike u djece pokazuje značajano nižu upalnu reakciju u usporedbi s otvorenom tehnikom. |
| Abstract (english) | Background and aim: The aim of this study was to compare inflammatory stress response between laparoscopic percutaneous inguinal ring suturing (PIRS) and open modified Marcy technique for pediatric inguinal hernia repair.
Methods: From May 2017 to April 2018, 32 male children with median age of 4.5 years undergoing inguinal hernia repair were included in randomized controlled trial. The patients were divided in two groups, by using random number generator, depending on surgical approach. The blood was tested in 3 time frames for white blood cells count (WBC), C-reactive protein (CRP), Interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α).
Results: Significant increase in concentration for all inflammatory biomarkers, that occur over time, has been found (P<0.001 for all). Additionally, it was also found that the type of surgery significantly influenced the level of WBC, CRP and IL-6 with Marcy showing a higher level of inflammatory response (WBC 11.4±3.1x109/L; CRP 11.5 mg/L; IL-6 11.0 pg/mL) than the PIRS (WBC 7.6±1.6x109/L; CRP 0.8 mg/L; IL-6 2.0 pg/mL) (P<0.001 for all). Similar pattern was also found for TNF-α (Marcy 16.8 pg/mL; PIRS 10.1 pg/mL), but correlation between surgery type and concentration of this biomarker was significant only at the 0.1 level (P=0.055). The mean operation time was significantly shorter (9±2 min) in PIRS group compared to Marcy group (25±7 min) (P<0.001). Significantly lower median of visual analog scale score (VAS) was found in PIRS group (VAS=2) compared to Marcy group (VAS=6)(P<0.001).
Conclusions: Use of laparoscopic (PIRS) technique in children shows significantly lower surgical stress in comparison to open hernia repair. |
