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

Yıl 2024, Cilt: 3 Sayı: 1, 21 - 26, 18.03.2024

Zeynep Şener Bahçe , Tülin Öztaş , Erkan Dalbaşı

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

Öz

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.

Anahtar Kelimeler

Antibiyotik, enfeksiyon, hemoroid

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

Öz

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.

Anahtar Kelimeler

Antibiotic, ınfection, hemorrhoid

Kaynakça

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