Özcem ÖFKELİ, Volkan ÖTER, MURAT ULAŞ, Erdal Birol BOSTANCI

ANASTOMOZ KAÇAĞINI SAPTAMAK İÇİN YENİ BİR YÖNTEM: MESANE İÇİ BASINÇ ÖLÇÜMÜ

Giriş: Rektal karsinom için low anterior rezeksiyon, tüm cerrahlar için teknik bir zorluktur. Rektal kanser için standart bir ameliyattır ve anal sfinkter koruyucu aşağı seviyeli anastomoz sağlar. Mesane içi basıncın intra- abdominal basınç için bir gösterge olması gerçeğine dayanarak, anastomoz kaçağını bu durumun neden olduğu karın içi değişiklikler nedeniyle öngörmek için de kullanılabileceğini düşünüyoruz. Gereç ve Yöntem: Ocak 2015 ile Ocak 2016 arasında rektal kanser nedeniyle low anterior rezeksiyon (ekstra peritoneal anastomozu yapılmış olan) geçiren 50 hasta çalışmaya dahil edildi. Hastaların intra vezikal basınç düzeyleri, postoperatif ilk 5 gün boyunca kaydedildi. Bulgular: Anastomoz kaçağı olan üç hasta vardı. Bu üç hastanın intra vezikal basınç ölçüm düzeyleri anastomoz kaçağı olmayan hastalaradan daha yüksek bulundu. Sonuç: İntravezikal basınç ölçümü, özellikle postoperatif 3. günden sonra anastomoz kaçağını öngörmek için yararlı bir yöntem gibi gözükmektedir. Tabii ki bizim çalışmamız, anastomoz kaçağı olan grubun çok az olması nedeniyle sınırlıdır. Çok merkezli prospektif çalışmalara ihtiyaç vardır.

A NOVEL METHOD TO PREDICT ANASTOMOTIC LEAKAGE: INTRAVESICAL PRESSURE

Introduction: Low anterior resection for rectal carcinoma is a technical challenge for all surgeons. It is a standart operation for rectal cancer and allows lower level anastomosis which preserves the anal sphincter. Based upon the fact that, intravesical pressure is a reflector for intraabdominal pressure, we suggest that it can also be used to predict anastomotic leakage because of intraabdominal changes that caused by this phenomenon. Materials and Method: Fifty patients who undergone low anterior resection (who had extra peritoneal anastomosis) for rectal cancer between January 2015 and January 2016 were included in the study. Patients’ intravesical pressure levels of postoperative 5 days were all recorded. Results: There were three patients who had anastomotic leakage. Intravesical pressure levels of this three patients were higher than who did not have any anastomotic leakage. Conclusion: Intravesical pressure measurement seems to be a useful tool to predict an anastomotic leakage especially after postoperative third day. Of course our study is limited becasue of the small number of anastomotic leakage group. We think that it deserves to study this subject in a larger scale.

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