Gebelerde Komplike Hemoroidlerin Cerrahi Tedavisi Güvenli mi? 13 Hastanın Retrospektif Analizi ve Literatürün Gözden Geçirilmesi

Giriş: Literatürde çok sınırlı sayıda olan; gebelerde komplike hemoroidlerde cerrahi tedavinin güvenli olup olmadığını belirlemek amacı ile kliniğimizde gebelik sürecinde cerrahi tedavi uygulanan hastaların tedavi sonuçlarını sunmayı amaçladık.Gereç ve Yöntemler: Ocak 2011 ve Nisan 2018 yılları arasında hemoroid cerrahisi uygulanan hastaların dosyaları geriye dönük olarak incelendi. Konservatif ve/veya medikal tedaviden fayda görmeyen hastaların yaş, gebelik ayı, daha önceden hemoroidal hastalık ve anorektal cerrahi öyküsü, başvuru şikayeti, ek hastalıkların varlığı, vücut kitle indeksi, daha önce medikal tedavi alıp almadığı, fizik inceleme bulguları, kolonoskopi/rektoskopi sonuçları, eşlik eden diğer anorektal bölge hastalıkları, yapılan ameliyat tekniği, komplikasyon varlığı, hastanede kalış süresi, kontrol muayenesi ve tedavi sonuçları kayıt altına alındı.Sonuç: Hemoroid cerrahisi uygulanan kadın hastaların 13 (%17.8)' ü gebe idi. Hastaların 8 (%61.5)' i 3. trimesterde, 4 (%30.7)' ü 2. trimesterde ve 1 (%7.6)' i 1. trimesterde idi. En sık başvuru şikayeti ağrı ve kanama idi. Ortalama yaş 30 (20-40) yıl ve vücut kitle indeksleri 27 (23-36) kg/m2idi. Hastaların 9 (%69.2)' na hemoroidektomi (milligan morgan veya ferguson tekniği ile), 2 (%15.3)' ne hemoroidektomi ve sfinkterotomi, 1 (%7.6) 'e hemoroidopeksi ve 1 (%7.6)' ne trombektomi uygulandı. Ortalama ameliyat süresi 30 (10-35) dk ve hastanede kalış süresi 2 (1-3) gün idi. Erken dönemde 11 (%84.6) hastada ağrı ve 1 (%7.6) ileus tablosu görüldü. Hastalarımızda erken ve geç dönemde başka komplikasyon olmadı. Tartışma: Gebelik sürecinde oldukça sık görülen hemoroidal hastalığın öncelikli tedavisi medikal ve konservatif yöntemler olmalıdır. Ancak akut hemoroidal hastalığın varlığında; yeterli cerrahi, anestezi ve teknik olanaklara sahip merkezlerde hemoroidal cerrahi düşük komplikasyon oranları ile uygulanabilmektedir.

Anahtar Kelimeler:

Hemoroid, Gebelik, Hemoroidektomi

A practical method for hair seperation at otoplasty surgery: hair gel

Hair interference is a common problem at otoplasty, facelift and scalp surgeries and it is a threat for sterility. Also it discomforts the surgeon and makes difficulty for concentrating on operation. In this manner it can result in longer operation time.At scalp operations metal combs1 and hair clips2 have been used for hair seperation. At facelift operations, using rubber bands that are made by cutting surgical gloves fingers for bunching hairs at the incison lines at the postuaricular area is a cheap and practical method.3 McGivney instrument, that has been designed for rubber band ligation of hemorrhoids, has been used for bunching hairs4. Also an artery clip and haemorrhoid band can be used for same purpose: The band is mounted on to an artery clip that grasps the hair section while the band is rolled down over the clip.5At ear surgeries, surgical drapes are preferred worldwide for preparing surgical site.While removing the drape it can cause rupture or fracture of hair strands and also patients operated under local anesthesia can feel pain. Kayıran6 has used a postauricular adhesive tape to prevent hair interference and he reported that the tape was easily removed by peeling it off after 70% alcohol was sprayed on. Latex or silicone swimming cap has been used for tucking the hair into cap behind the ears.7 A medical elastic stocking open at the ears and at the face has been used for preventing hair interference.8 We are using hair gel for preventeing hair interference at otoplasty surgeries.Hairs are reclined posteriorly by the help of hair gel (Figure 1). Afterwards surgical site is cleaned with povidone iodine and closed with sterile clothes. Not a hair strand goes out of sterile clothes and interferes with operation. Patients are told to remove dreessing and have a shower at the postoperative second day. None of the patients complain about keeping hair gel on hairs for 2 days. Using hair gel for hair seperation at otoplasty surgery is a cheap and practical method.

Keywords:

otoplasty ear, hair interference, hair gel,

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