Introdução: A incidência de hérnia abdominal em pacientes cirróticos é elevada, em torno de 20%. Em casos de ascite volumosa, a incidência atinge valores até 40%.Uma das principais e mais graves complicações no pósoperatório (PO) de correção de hérnias de pacientes cirróticos é a insuficiência renal aguda, conhecida como acute kidney injury - insuficiência renal aguda (AKI). Objetivos: O objetivo deste estudo é analisar a função renal de pacientes cirróticos submetidos à cirurgia de correção de hérnias abdominais em nosso serviço. Além disso, comparar os pacientes que apresentam AKI PO com os demais, para determinar os fatores relacionados à sua ocorrência. Métodos: Seguimento de pacientes cirróticos submentidos à cirurgia de hérnia entre 2001 e 2014 no Serviço de Transplante de Fígado. Foram coletados exames laboratoriais para avaliar a função renal no pós-operatório rotineiramente. A AKI foi definida com base no consenso do clube da ascite em 2015. Resultados: Dos 174 pacientes incluídos, ocorreu AKI em 58 pacientes (34,9%). Houve diferença entre grupos para as seguintes variáveis: model for end-stage liver disease - modelo para doença hepática terminal (MELD) inicial, creatinina basal e creatinina, o grupo com AKI apresentou médias superiores ao grupo que não apresentou AKI. No grupo do AKI PO, 74,1% das cirurgias, foram realizadas em caráter de emergência, enquanto que no grupo sem AKI PO, 34,6%. No grupo AKI,90,4% dos indivíduos apresentaram complicações no PO, enquanto no grupo sem AKI, 29,9%. As variáveis Idade, MELD inicial, creatinina basal e creatinina no pós-operatório inicial (POI) foram estatisticamente significantes na análise de sobrevida. Conclusão: Existe uma associação entre AKI PO e cirurgia de emergência e AKI PO e complicações PO. Os fatores relacionados à maior ocorrência de AKI em pacientes cirróticos submetidos à cirurgia de hérnia são o MELD inicial, creatinina basal, creatinina POI. O preparo de pacientes cirróticos com hérnia abdominal antes de procedimentos cirúrgicos deve ocorrer sistematicamente pois apresentam alta incidência de AKI PO / Background: The incidence of abdominal hernia in cirrhotic patients is as higher 20% and in cases of major ascites the incidence may increase up to 40%. One of the main and most serious complications in the postoperative period of cirrhotic patients is acute renal failure, known as acute kidney injury (AKI). Objectives: The objective of this study is to analyze the renal function of cirrhotic patients undergoing hernia surgery in our service, and compare the patients who presented AKI postoperative (PO) with the others, to determine the factors related to their occurrence. Methods: Follow-up of cirrhotic patients who underwent hernia surgery between 2001 and 2014. Laboratory tests were routinely collected on the PO period. AKI was defined based on the consensus of the ascite´s club in 2015. Results: Of 174 patients included, the primary outcome of AKI occurred in 58 (34.9%) patients. We observed that there was a significant difference between the groups in the variables: initial MELD, basal creatinine, and creatinine POI, the group with AKI PO had averages higher than the group that did not have AKI PO. In the AKI PO group, we observed that 74.1% of the patients had emergency surgery, whereas in the group without AKI PO, we had 34.6%. In the group with AKI PO, we observed that 90.4% of the individuals had complications in the PO, whereas in the group without AKI PO, we had 29.9%. We observed that the variables Age, Initial MELD, Baseline Creatinine, and Creatinine POI were statistically significant for survival analysis. Conclusions: There is an association between AKI PO and emergency surgery and also between AKI PO and complications after surgery. The factors related to higher occurrence of AKI PO in cirrhotic patients underwent hernia surgery are initial MELD, basal Cr, Cr Poi. We believe that cirrhotic patients with abdominal hernia must be well prepared before surgery because they present high incidence of AKI PO

<p>UVOD: Ingvinalna hernioplastika predstavlja najučestaliju operaciju u abdominalnoj hirurgiji. U istorijatu herniologije su se razvijale različite ideje, te iz njih nastale operativne metode, koje su imale za cilj formiranje kvalitetnog vezivnog tkiva na mestu kilnog defekta. Danas postoje brojne hirur&scaron;ke tehnike, bazirane na tenzionim ili beztenzionim principima, uz primenu hirur&scaron;kih mrežica, otvorenim pristupom, kao i laparoskopskim tehnikama. Zajednički cilj navedenih metoda je kreiranja idealne hernioplastike ingvinalnih kila. I pored postojanja ogromnog broja hirur&scaron;kih procedura i tehnika, jo&scaron; uvek ne postoji tzv. &raquo;prava hernioplastika&laquo; koja bi zadovoljila sve potrebne zahteve vezane za problem ingvinalnih hernija. CILJ I HIPOTEZA: Cilj rada je bio da se napravi uporedna analiza između dve različite hirur&scaron;ke tehnike otvorenim pristupom, konvencionalne tenzione suturne hernioplastike, te beztenzione tehnike, uz kori&scaron;ćenje hirur&scaron;kih mrežica ( mesh ). Kori&scaron;ćeni su sledeći parametri tokom istraživanja: određivanje nivoa postoperativnog bola prema numeričkoj skali, vizuelno-analognoj te kategorijskoj skali bola; određivanje samostalne fizičke aktivnosti; (savijanje nogu, naprezanje trbu&scaron;nih mi&scaron;ića, ustajanje) u neposrednom postoperativnom periodu; gradacija nivoa mi&scaron;ićne snage, određivanje vremenskog perioda kada se pacijenti uspevaju vratiti svojim svakodnevnim aktivnostima i radnim obavezama; određivanje stope postoperativnog morbiditeta i mortaliteta te određivanje stope ranog recidiva bolesti. RADNA HIPOTEZA: Beztenzionu ingvinalnu hernioplastiku karakteri&scaron;e znatno manja operativna trauma, &scaron;to ima za posledicu manji lokalni i generalizovani odgovor organizma na stres. Kod bolesnika operisanih beztenzionom metodom očekuje se manji intenzitet bola, kraće zadržavanje u hospitalnim uslovima, manji procenat postoperativnih komplikacija, brži povratak uobičajenim fizičkim i radnim aktivnostima i znatno manji stepen recidiva bolesti. Pretpostavlja se da beztenziona ingvinalna hernioplastika u poređenju sa konvencionalnom uzrokuje manju nelagodnost za pacijente, znatno manji postoperativni bol i bolju mi&scaron;ićnu aktivnost. Pobolj&scaron;anje mi&scaron;ićne aktivnosti ogleda se u lak&scaron;oj vertikalizaciji, kvalitetnijem kretanju uz manje bolan hod, bez povijanja tela na stranu operativne rane. MATERIJAL I METODE: Istraživanje je prospektivna, kliničko- statistička studija sa praćenjem parametara (preoperativnih, intraoperativnih i postoperativnih) kod svakog operisanog bolesnika. Studija je obuhvatila seriju od 200 pacijenata hospitalizovanih na Klinici za abdominalnu, endokrinu i transplantacionu hirurgiju Kliničkog centra Vojvodine, od decembra 2002. do avgusta 2007.godine, svrstanih u dve jednake grupe po 100 pacijenata, odabranih metodom slučajnog izbora. Prva, ispitivana grupa obuhvatila je pacijente operisane beztenzionim procedurama, druga, kontrolna grupa je obuhvatila pacijente operisane konvencionalnim, tenzionim tehnikama. Kori&scaron;ćeni metod rada je kliničko statistički sa praćenjem svih potrebnih fiziolo&scaron;kih parametara, a dobijeni rezultati su analizirani i međusobno upoređivani statističkim metodama multifaktorijalne analize. Pronađene vrednosti su međusobno upoređene parametrijskim i neparametrijskim testovima značajnosti na nivou p&lt;0.05. REZULTATI: komparacija između dve ispitivane grupe je vr&scaron;ena tokom preoperativnog, intraoperativnog i postoperativnog perioda, različitim statističkim parametrima. Konstatovana je, statističkom analizom, homogenost grupa u smislu starosne dobi i polne distribucije, kao i lokalnog preoperativnog nalaza vezanog za tip, veličinu i lokalizaciju kila, kao i spram klasifikacije hernija. U sledećim parametrima je ustanovljena statistički signifikantna razlika: postoperativni bol, gradacija mi&scaron;ićne snage, rana fizička aktivnost, količina utro&scaron;enih analgetika, dužina hospitalizacije, prisutnost obostranih kila, povratak radnim aktivnostima i obavezama, postoperativne komplikacije i recidiv bolesti. Dobijeni podaci su prikazani tabelarno, te delom u vidu grafikona i dijagrama. ZAKLJUČCI: 1. Kod pacijenata operisanih beztenzionom metodom evidentan je znatno manji postoperativni bol i brži oporavak i povratak uobičajnim dnevnim i radnim aktivnostima 2. Proceduru treba izvoditi u svim slučajevima sa prisutnim velikim defektima i razorenim zadnjim zidom ingvinalnog kanala 3 Beztenzionu hernioplastiku karakteri&scaron;e manji broj recidiva u poređenju sa otvorenim tenzionim hernioplastikama. 4. Pacijenti sa bilateralnim ingvinalnim i recidivnim hernijama imaju punu indikaciju za izvođenje beztenzione herioplastike sa ugradnjom mesh-a. 5. Preduslov za uspe&scaron;no obavljenu beztenzionu hernioplastiku je primena dovoljno velike proteze, odnosno mesh-a, dimenzija 15 x 10 cm.</p> / <p>INTRODUCTION: Inguinal hernioplasty is the most common surgical procedure in abdominal surgery. In the history of herniology have developed different ideas, and from them emerged operational methods, which are aimed at educating quality of connective tissue at the site of the hernia defect. Nowadays, there are numerous surgical techniques, based on the tensioned or tension-free principles, with the use of surgical mesh for open access as well as laparoscopic techniques. Common goal of these methods is creating ideal inguinal hernioplasty despite the existence of a huge number of surgical procedures and techniques, there is still no so-called &raquo;Proper hernioplasty &quot; that would satisfy all the necessary requirements related to the problem of inguinal hernia. AIM AND HYPOTHESIS: The aim of this study was to make a comparative analysis between two different open access surgical techniques conventional tension hernioplasty and tension-free techniques, with the use of surgical mesh .The following parameters were used during the research: determining the level of postoperative pain according to a numerical scale, visual analogue scale and categorical scale of pain; determining the initial independent physical activities: (bending the legs, straining abdominal muscles, getting up) in the immediate postoperative period; gradation levels of muscular strength, determination period when patients can return to their usual daily activities and work duties; determining the rate of postoperative morbidity and mortality and to determine rates of early recurrence of the disease. WORKING HYPOTHESIS: Tension-free inguinal hernioplasty characterized by significantly less operative trauma, which results in smaller local and generalized body&#39;s response to stress. In patients operated by the tension. free method is expected to lower the intensity of pain, a shorter stay in the hospital setting, a smaller percentage of postoperative complications, faster return to normal physical and occupational activities and much lower degree of disease recurrence. It is assumed that the tensional. free inguinal hernioplasty compared with conventional causes less discomfort for patients, significantly less postoperative pain and better muscle activity. Better muscle activity is reflected in a facilitated mobilization, quality of movement and less painful gait, without bending the body at the side of the surgical wound. MATHERIAL AND METHODS: The research was a prospective, clinical-statistical study of the monitoring parameters (preoperative, intraoperative and postoperative) in each of the operated patients. The study involved a series of 200 patients hospitalized at the Clinic for Abdominal, Endocrine and Transplantation Surgery, Clinical Center Vojvodine, from December 2002 to August 2007, divided into two groups of 100 patients, randomly chosen. First, the test group consisted of patients operated by the tension-free procedures, the other, the control group consisted of patients operated on conventional techniques. The method used is the work of clinical statistical tracking of all necessary physiological parameters, and the results were analyzed and compared with each other with multivariate statistical methods of analysis. Found values are compared with each other parametric and non-parametric tests of significance at p &lt;0.05. RESULTS: The comparison between the two study groups was performed during the preoperative, intraoperative and postoperative period, using various statistical parameters. It was noted using the statistical analysis, the homogenity of the groups in terms of age and sex distribution, as well as local preoperative findings related to the type, size and location pounds as well as towards the classification of hernias. In the following parameters is statistically significant difference: postoperative pain, graduations of muscle strength, healing of physical activity, the quantity of analgesics, length of hospitalization, the presence of bilateral hernias, the return of work activities and responsibilities, postoperative complications and recurrence. The data are presented in tables, and partly in the form of graphs and charts. CONCLUSIONS: 1. In patients operated by the tension-free obvious method is significantly less postoperative pain and faster recovery and return to usual daily and work activities 2. The procedure should be performed in all cases with the presence of large defects and lacerated back wall of the inguinal canal 3. Tension-free hernioplasty is characterized by a smaller number of recurrence compared with conventional hernioplasty 4. Patients with bilateral inguinal hernias and recurrent have a full indication of the performance of the tension-free hernioplasty with the installation of mesh. 5. A prerequisite for the successful work carried out tension-free hernioplasty application is large enough prosthesis ( mesh ), measuring 15 x 10 cm.</p>