Ahmet ERTÜRK, İBRAHİM KARAMAN, AYŞE KARAMAN, Engin YILMAZ, ÇAĞATAY EVRİM AFŞARLAR, Derya ERDOĞAN, YUSUF HAKAN ÇAVUŞOĞLU, ÖZLEM BALCI EKMEKÇİ, İSMET FARUK ÖZGÜNER

Laparotomi yapılan hastalarda brid ileus risk faktörleri ve tedavi yaklaşımlarının değerlendirilmesi

Amaç: Postoperatif yapışıklıklar intestinal obstrüksüyona yol açması, reoperasyon durumlarında abdominal eksplorasyonu zorlaştırması, organ yaralanmalarına sebep olması nedeniyle hem hasta hem de hekimler için önemli bir klinik durumdur. Bu çalışmada brid ileus gelişimine etki eden faktörlerin saptanması ve brid ileusdaki tedavi sonuçlarının değerlendirilmesi amaçlanmıştır.Gereç ve Yöntemler: 2005-2010 yılları arasında çeşitli nedenlerle laparotomi yapılan hastalar brid ileus gelişimi açısından retrospektif olarak değerlendirildi. Bulgular: Bu çalışmaya laparotomi yapılan 3271 hasta dahil edildi. Apandisit en sık laparotomi endikasyonuydu (%66). 152 hastada (%4,6) postoperatif brid ileus geliştiği tespit edildi. Bunların %88’inin postoperatif ilk 6 ayda, %99’unun da ilk 3 yıl içinde geliştiği görüldü. Yaş ve cinsiyet ile brid ileus gelişimi arasında ilişki yoktu. Vakaların %23’ü kirli vasıfta ameliyatlardı. Temiz, temiz kontamine ameliyatlardan sonra brid ileus gelişme oranı %3,4 iken, kontamine ve kirli ameliyatlardan sonra bu oran %10,9 olarak bulundu. Batın içerisine dren yerleştirilmesinin brid ileus gelişimini etkilemediği saptandı. Ameliyat süresi uzadıkça postoperatif brid ileus gelişme oranının arttığı tespit edildi. Ayrıca ameliyatta Meckel divertikülü gibi ek patolojiler araştırılan hastalarda brid ileus gelişme oranının 3 kat arttırdığı görüldü.Brid ileus gelişen hastaların %61’i nonoperatif-konservatif yollarla tedavi edilirken %39’unda cerrahi girişim gerektiği tespit edildi. Sonuçlar: Çalışmamızda batın içinde uygulanan ek girişimlerin, operasyon süresinin uzun olmasının ve intraperitoneal kontaminasyonun brid ileus gelişimini artırdığı gösterilmiştir. Bu konulara dikkat edilmesinin brid ileus gelişimini azaltabileceği düşünülmüştür. Çocuk yaş grubunda uygun vakalarda konservatif tedavi ile daha yüksek oranlarda başarı sağlanabileceği kanısına varılmıştır.

Anahtar Kelimeler:

Postoperatif adezyon, intestinal obstrüksiyon, çocuk, yenidoğan

Evaluation of adhesive ileus risk factors and treatment modalities among the patients undergoing laparotomy

Aim: Postoperative adhesions become a serious clinical state both for the patients and physicians, in case of reoperation, because adhesions make exploration difficult, may induce organ injury and so increases the operative time. In this study we aimed to asses the factors influencing the developement of brid ileus and to analyse the results of treatment.Material and Methods: In terms of adhesive ileus development, a retrospevtive review of laparatomy performed patients in our hospital’s pediatric surgery department was conducted. Results: In this study 3271 patients were included. Most common indication for prior laparotomy was appendicitis (66%). Median age was 8,2 years and 61% of patients were male. Median follow up period was 5 years. Adhesive ileus occurred in 152 patients (4.6%). 88% of adhesive ileus occurred within the first 6 months and 99% within first 3 years. There were no significant relationship among patient age, gender and adhesive ileus development. 23% of the all cases were soiled abdominal procedures. The incidence of adhesive ileus was 3,4% after clean procedures and 10,9% after contaminated and soiled abdominal procedures. The drainage materials that were used following contaminated operations did not affect the development of adhesive ileus. Mean operation time was 60 minutes. It was observed that prolonged operation time increased the development of adhesive ileus, and also exploring additional pathologies such as Meckel’s diverticulum increased adhesive ileus incidence 3 times more.Conservative treatment was successful in 61% of the patients with adhesive ileus and only %39 of them were operated for adhesions. Patients under the age of one with adhesive ileus required surgical correction more frequently than the other age groups. The success rate of conservative treatment was higher in patients who are older than 1 year old and in the setting of first adhesive ileus attack. Conclusion: This study demonstrated that traumatic and unnecessary interventions to tissues, prolonged surgery time and intraperitoneal contamination during the operation have increased the adhesive ileus development. Additionally, we suppose that conservative treatment of adhesive ileus in children has high success rate.

Keywords:

Postoperative adhesion, intestinal obstruction, child, newborn,

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