Ramazan TOPÇU, İsmail SEZİKLİ, Murat KENDİRCİ, İbrahim Tayfun ŞAHİNER

Ostomi kapatılan hastalarda negatif basınçlı insizyon yönetim sistemi kullanımının etkinliği

Amaç:Kolorektal cerrahide, son yıllarda özellikle stoma kapatıldıktan sonra insizyon yerinde yara iyileşmesi esnasında postoperatif komplikasyonları iyileştirmeye yönelik çalışmalar artmıştır. Özellikle cerrahi alan enfeksiyonları(CAE) ve yara ayrışması için negatif basınçlı insizyon kapama yöntemi (NBİKY) uygulamaları başlamıştır. Çalışmalarda potansiyel olarak kontamine olma olasılığı yüksek yaralar üzerine uygulanan insizyonel negatif basınç uygulanması, CAE ve yara ayrışma gibi komplikasyonlar oranlarında azalma sağladığına dair veriler bulunmaktadır. Bu çalışmada amaç, stoma kapatılması sonrası yara iyileşmesi esnasında postoperatif komplikasyonların üzerinde NBİKY’nin etkili olup olmadığını araştırmaktır. Yöntem: Ocak 2018- Aralık 2020 tarihleri arasında stoma kapatılması ameliyatı olmuş 64 hasta retrospektif olarak incelendi. Hastalar NBİKY uygulananlar ile konvansiyonel yara bakımı (KYB) yapılanlar olarak iki grupta incelendi. Bulgular:Retrospektif olarak değerlendirilen 64 hastanın %39,6’sına (n:25) NBİKY, %60,4’üne (n:39) KYB uygulandı. Her iki grupta da en fazla kolorektal kanserlere bağlı stoma açıldığı görüldü .Her iki grup postoperatif yara yeri komplikasyonu olan CAE açısından karşılaştırıldığında istatiksel olarak anlamlı fark sapandı (p: 0,032).1.grupta 2 (%8,0) 2.grupta 12 (%30,8) hastada cerrahi alan enfeksiyonu görüldü. Yara ayrışması, evisserasyon, skar açısından her iki grup karşılaştırıldığında istatiksel olarak anlamlı fark saptanmadı. Hastanede kalış süresi ve postoperatif insizyonel herni açısından karşılaştırıldığında belirgin istatiksel anlamlılık görüldü (Sırasıyla p: 0,050 ve p: 0,018) . Sonuç:NBİKY uygulaması konvansiyel yara bakımı ile karşılaştırıldığında kapatılan stoma insizyon yerinde belirgin olarak CAE, hastanede kalış, maliyet ve postoperatif herni oluşumunu azaltması konusunda üstün olduğu görülmektedir. Bu sonuçlar rutin uygulama açısından umut vericidir. Ancak bu çalışmaları destekleyecek büyük vaka sayıları olan randomize kontrollü prospektif çok merkezli çalışmalara ihtiyaç olduğunu düşünmekteyiz.

Anahtar Kelimeler:

Stoma, Negatif basınçlı insizyon kapama yöntemi, Yara yeri enfeksiyonu

Efficiency of using negative pressure incision management system in patients with stoma closure

Aim: In colorectal surgery, studies have increased in recent years to improve postoperative complications during woundhealing at the incision site, especially after stoma closure. Negative pressure incision closure method (NPİCM) applications have started, especially for surgical site infections (SSİ) and wound dehiscence. Studies have shown that the application of negative incisional pressure on potentially contaminated wounds reduces the rate of complications such as surgical site infection and wound dehiscence. The aim of this study is to investigate whether NPİCM is effective on postoperative complications during wound healing after stoma closure. Material and Methods: 64 patients who underwent stoma closure surgery between January 2018 and December 2020 were retrospectively analyzed. The patients were examined in two groups as those who underwent NPİCM and those who received conventional wound care (CWC). Results: Of the 64 retrospectively evaluated patients, 39.6% (n:25) NPİCM was performed, 60.4% (n:39) underwent CWC. It was observed that stoma was opened mostly due to colorectal cancers in both groups. When both groups were compared in terms of SSİ with postoperative wound complications, there was a statistically significant difference (p: 0.032). 2 in group 1 (8.0%) 12 in group 2 ( Surgical site infection was observed in 30.8% of the patients. No statistically significant difference was found between the two groups in terms of wound dehiscence, evisceration, and scarring. When the length of hospital stay and postoperative incisional hernia were compared, significant statistical significance was observed (p: 0.050 and p: 0.018, respectively). Conclusion: When NPİCM application is compared with conventional wound care, it is seen that it is superior in reducing SSI, hospital stay, cost and postoperative hernia formation at the closed stoma incision site. These results are promising for routine application. However, we think that randomized controlled prospective multicenter studies with large case numbers are needed to support these studies.

Keywords:

Stoma, Negative pressure incision closure method, Wound infection,

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