Dev Omfalosel: 23 Hasta; Üç Farklı Yaklaşım

Amaç: Omfalosel karın ön duvar gelişim bozukluğudur. Silo yöntemi, cilt flepleri ve sentetik maddeler ile kapama tedavi seçenekleridir. Erken dönemde uygulanan cerrahi tedavilerin morbidite ve mortalitesindeki yükseklik dev omfalosellere yaklaşımda cerrahi dışı teknikleri ön plana çıkarmaktadır. Bu çalışmada omfalosel tedavisinde kullanılan primer kapatma, silo ve vakum yardımlı kapatma (VAC) yöntemlerinin avantaj ve dezavantajları karşılaştırılması amaçlanmıştır. Materyal ve Metot: 2005- 2020 yılları arasında kliniğimizde tedavi edilen dev omfalosel tanılı 23 hastaya uygulanan 3 farklı tedavi yöntemi karşılaştırıldı. 14 hastaya tedavide silo yöntemi kullanıldı. 7 hastaya primer onarım yapıldı. Birincil kapama yapılan 2 hastaya meş kullanıldı. 2 hasta için ise VDK sistemi tercih edildi. Tedaviler hastanede kalış süresi, epitelizasyon süresi, enfeksiyonlar ve taburculuk sonrası sorunlar açısından tartışıldı. Bulgular: Omfalosel tedavisinde klasik yöntemler olan silo yöntemi ve primer onarım sonrasında sepsis, ileus, gastroözefageal reflü ve solunum sistemi sorunları ile karşılaşıldı. VDK tekniğinde, epitelizasyon ve iyileşme daha hızlı idi ve komplikasyon olarak sadece bilateral inguinal herni gelişti. Sonuç: Diğer klasik yöntemlere göre epitelizasyonu hızlandırıcı ve enfeksiyonlardan koruyucu etkisi ile kısa dönemde iyileşmeyi sağlayan ve komplikasyonları en aza indiren VDK sistemi, dev omfalosellerin tedavisinde ilk tercih edilebilecek yöntemler arasında akla gelmelidir.

Anahtar Kelimeler:

Dev Omfalosel, silo, birincil kapama, VDK

Giant Omphalocele: 23 Patients; Three Different Approaches

Objective: Omphalocele is the ventral body wall maldevelopment. Early surgical interventions in the treatment of giant omphaloceles (GO) can increase morbidity and mortality. In this study, it was aimed to compare the advantages and disadvantages of primary closure, silo and vacuum assisted closure (VAC) methods used in omphalocele treatment. Materials and Methods: Three different treatment methods applied to 23 patients with giant omphalosis who were treated in our clinic between 2005 and 2020 were compared. Silo method was used in the treatment of 14 patients. Primary repair was performed in 7 patients. Mesh was used in 2 patients who underwent primary repair. The VAC was preferred for 2 patients. Treatments were discussed in terms of hospital stay, epithelization time, infections, and post-discharge problems. Results: Sepsis, ileus, gastroesophageal reflux and respiratory system problems were encountered after the silo method and primary repair, which are the classical methods of omphalocele treatment. VAC in technique, epithelization and healing were faster and only bilateral inguinal hernia developed as a complication. Conclusion: Minimizing complications with its effects that increase epithelization and prevent infection, VAC when other methods are considered in the treatment of giant omphalocele, it should be the first method that comes to mind.

Keywords:

Giant omphalocele, primary closure, silo, VAC,

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