Hemoroid Cerrahisi Öncesi Profilaktik Antibiyotik Tedavisi ve Barsak Temizliği Yapılmalı mı?

Year 2024, , 21 - 26, 18.03.2024

Zeynep Şener Bahçe , Tülin Öztaş , Erkan Dalbaşı

https://doi.org/10.57221/izmirtip.1286196

Abstract

Özet
Amaç
Cerrahi antibiyotik profilaksisinin (CAP) endike olduğu alanlar geniş oranda belirlenmiş olmasına rağmen bazı CAP uygulamalarında hâlen tartışmalar devam etmektedir. Bu çalışmanın amacı hemoroid ameliyatı öncesi profilaktik antibiyotik kullanımı ve barsak temizliğinin gerekli olup olmadığını belirlemektir.
Gereç ve Yöntem
Çalışmada grade 3-4 hemoroid tanısı konmuş ve opere olmuş 16-.45 yaş aralığındaki hastaların verileri retrospektif olarak değerlendirildi. Hastalar her biri 250 hastadan oluşan iki gruba ayrıldı. Birinci grup ameliyat öncesi veya sonrası antibiyotik uygulanması ve barsak temizliği yapılmayan hastaları kapsıyordu. İkinci grup ise ameliyat öncesi ve sonrası tek doz antibiyotik tedavisi (seftriakson 1000 mg) ve barsak temizliği (sodyum fosfat lavman 135 ml) uygulanan hastalardan oluşuyordu. Ameliyat sonrası ateş, lökositoz, idrar yapmada zorlanma, yara yerinde indurasyon varlığı değerlendirildi. Operasyon sonrası bir ay süresince hastalar takip edildi. Her iki grup hastalarda postoperatif enfeksiyon oranı karşılaştırıldı.
Bulgular
Çalışmamıza Ferguson ve Milligan-Morgan hemoroidektomi ve lateral internal sfinkterotomi yapılan toplam 500 hasta dahil edildi. İki grup arasında yaş, cinsiyet, operasyon süresi, hastanede kalış süresi, postoperatif analjezik ihtiyacı açısından istatistiksel anlamlı farklılık saptanmadı (p>0.05). Her iki gruptaki hastalar arasında postoperatif 1.hafta ve 1. ayda enfeksiyon açısından istatistiksel anlamlı farklılık yoktu (p>0.05).
Sonuç
Hemoroid ameliyatları ameliyat öncesi veya sonrası antibiyotik kullanılmadan ve barsak temizliği yapılmadan güvenle yapılabilir.

Keywords

Antibiyotik, enfeksiyon, hemoroid

Should profılactıc antıbıotıc treatment and ıntestıne cleanıng be made before hemoroıd surgery?

Abstract

Abstract
Objective
Although areas where surgical antibiotic prophylaxis (SAP) is indicated are widely identified, discussions are still ongoing in some SAP applications. The aim of this study is to determine whether prophylactic antibiotic use and bowel cleaning are necessary before hemorrhoid surgery.
Material and Methods
In the study, the data of patients between the ages of 16-45 who were diagnosed with grade 3-4 hemorrhoids and operated were retrospectively evaluated. The patients were divided into two groups of 250 patients each. The first group included patients who did not receive antibiotics and bowel cleaning before or after surgery. The second group consisted of patients who underwent a single dose of antibiotic therapy (ceftriaxone 1000 mg) and bowel cleaning (sodium phosphate enema 135 ml) before and after surgery. After the surgery, fever, leukocytosis, difficulty urinating, indignation at the wound site were evaluated. Patients were followed up for a month after the operation. Postoperative infection rate was compared in both groups of patients.
Results
A total of 500 patients were included in our study who underwent Ferguson and Milligan-Morgan hemorrhoidectomy and lateral internal sphincterotomy. There was no statistically significant difference between the two groups in terms of age, gender, duration of operation, hospital stay, postoperative analgesic need (p>0.05). There was no statistically significant difference in infection between patients in both groups in postoperative 1st week and 1st month (p>0.05).
Conclusion
Hemorrhoid surgeries can be performed safely before or after surgery without the use of antibiotics and without intangible cleaning.

Keywords

Antibiotic, ınfection, hemorrhoid

References

• 1. Lobo SJ, Bhuyan C, Gupta SK, Dudhamal TS. A comparative clinical study of snuhik sheera sutra, tilanala kshara sutra and apamarga kshara sutra in Bhagandara (Fistula in Ano). Ayu 2012; 33: 85–91.
• 2. Gallo G, Sacco R, Sammarco G. Hemorrhoids Coloproctology. In: Ratto C, Parello A, Litta F, (editors) Textbook of Epidemiology of Hemorrhoidal Disease. Springer; International Publishing. 2018:3-7.
• 3. Wasey N, Baughan J, de Gara CJ. Prophylaxis in elective colorectal surgery: the cost of ignoring the evidence. Can J Surg 2003;46:279-84.
• 4. Goh M, Chew MH, Au-Yong PS, Ong CE, Tang CL. Nonsurgical faecal diversion in the management of severe periana lsepsis: a retrospective evaluation of the flexible faecal management system. Singapore Med J. 2014;55:635-69.
• 5. Singh A, Ahmed K, Aydin A, Khan MS, Dasgupta P. Fournier's gangrene. A clinical review. Arch Ital Urol Androl. 2016;88:157-64.
• 6. Çelen MK. Çocuk ürolojisinde akılcı antibiyotik kullanımı ve profilaksi. Çocuk Cerrahisi Dergisi. 2016;30:80-4.
• 7. Sirikurnpiboon S, Awapittaya B, Jivapaisarnpong P. Ligation of intersphincteric fistula tract and its modification: Results from treatment of complex fistula. World J Gastrointest Surg. 2013;5:123-28.
• 8. Aysan El, Aren A, Ayar E. A prospective, randomized, controlled trial of primary wound closure after lateral internal sphincterotomy. Am J Surg. 2004;187:291-94.
• 9. Gallo G, Martellucci J, Sturiale A, Clerico G, Milito G, Marino F, et al. Consensus statement of the Italian society of colorectal surgery (SICCR): management and treatment of hemorrhoidal disease. Techniques in Coloproctology. 2020;24:145-64.
• 10. Sielezneff I, Salle E, Lecuyer J, Brunet C, Sarles JC, Sastre B. Early post-operative morbidity after hemorrhoidectomy using the Milligan–Morgan technique. A retrospective study of 1134 cases. J Chir. 1997;134:243-47.
• 11. De Paula PR, Matos D, Franco M, Speranzini MB, Figueiredo F, de Santana IC, et al. Why do anal wound sheal adequately? A study of the local immune inflammatory defense mechanisms. Dis Colon Rectum. 2004;47:1861-67.
• 12. Applebaum GD, Donovan S. Escherichia coli meningitis in a human immuno deficiencyvirus-infected man after outpatient hemorrhoidectomy. Clin Infect Dis. 1999;29: 448-49.
• 13. Oh HK, Moon SH, Ryoo S, Choe EK, Park KJ. Results of surgical treatment on benign anal diseases in Korean HIV-positive patients. J Korean Med Sci. 2014;29:1260-65.
• 14. Burke EC, Orloff SL, Freise CE, Macho JR, Schecter WP. Wound healing after anorectal surgery in human immune deficiency virus-infected patients. Arch Surg. 1991;126:1267-70.
• 15. McConnell JC, Khubchandani IT. Long-term follow-up of closed hemorrhoidectomy. Dis Colon Rectum. 1983;26:797-99.
• 16. Besset JF. Complications following hemorrhoidectomy performed by the techniqueused at St Mark’s Hospital in London. Phlebologie. 1984;37:109-19.
• 17. Seow-Choen F, Ho YH, Ang HG, Goh HS. Prospective randomised trial comparing pain and clinical function after conventional scissorsexcision/ligation vs. diathermyexcision without ligation for symptomatic prolapsed hemorrhoids. Dis Colon Rectum. 1992;35:1165-69.
• 18. Asif M, Mirza AA, Saeed A. Outcome of peri-anal surgeries without use of prophylactic antibiotics, interms of post operarative wound infection. Pak Armed Forces Med J. 2017;67:775-78
• 19. Ibrahim S, Tsang C, Lee YL, Eu KW, Seow-Choen F. Prospective randomised trial comparing pain and complications between diathermy and scissors for closed hemorrhoidectomy. Dis Colon Rectum. 1998;41:1418-20.
• 20. Bonardi RA, Rosin JD, Stonesifer GL, Bauer FW. Bacteremi asassociated with routine hemorrhoidectomies. Dis Colon Rectum 1976;19:233-36.
• 21. Cihan A, Mentes B, Sucak G, Karamercan A, Naznedar R, Ferahköşe Z. Fournier’s Gangrene after hemorrhoidectomy: association with drug-induced agranulocytosis. Dis Colon Rectum. 1999;42:1644-48.
• 22. Panwalker AP. Unusual infection sassociated with colorectal cancer. Rev Infect Dis. 1988;10:347-64.
• 23. Ala S, Saeedi M, Eshghi F, Mirzabeygi P. Topical metronidazole can reduce pain after surgery and pain on defecation in postoperative hemorrhoidectomy. Dis Colon Rectum. 2008;51:235-38.
• 24. Nguyen N, Yegiyants S, Kaloostian C, Abbas MA, Difronzo LA. The surgical care improvement project (SCIP) initiative to reduce infection in elective colorectal surgery: Which performance measures affect outcome? Am Surg. 2008;74:1012-16.