Laparoskopik bilateral tubal sterilizasyon operasyonu sırasında dren uygulanmasının postoperatif barsak hareketlerine etkisi

Öz

Amaç: Laparoskopik bilateral tubal sterilizasyon (L/S BTS) operasyonu sırasında dren kullanımı rutin bir uygulama olmayıp kanama şüphesi durumunda hastanın yakın takibini mümkün kılar. Bu çalışma ile L/S BTS operasyonu sırasında dren uygulamasının postoperatif dönemde gastrointestinal sistem açısından olası faydalarını araştırmak amaçlanmıştır.
Gereç ve yöntem: Turhal Devlet Hastanesi’nde Haziran 2019 ile Mart 2021 arasında L/S BTS uygulanmış hastaların dosya verileri retrospektif olarak tarandı. Çalışmaya L/S BTS operasyonu sırasında dren uygulanmış 22 hasta kadın ile L/S BTS operasyonu sırasında dren uygulanmamış olan 42 hasta kadın olmak üzere toplamda 64 hasta kadın dahil edildi. Gruplar; yaş, ameliyat sonrası gaz-feçes çıkışına kadar geçen süre, karın ağrısı, karın içi apse-hematom oluşumu, yara yeri enfeksiyonu, ameliyat süresi ve hastaneden taburcu olma süresi açısından karşılaştırıldı.
Bulgular: Dren kullanılan hastalar ile dren kullanılmayan hastalar karşılaştırdıklarında; dren kullanılan hastalarda gaz ve gaita çıkış saatlerinin daha erken olduğu bulundu (p=0,003 ve p=0,018). Ancak dren kullanılan hastalar ilk 12 saatte daha fazla abdominal ağrı hissetmekteydiler (p=0,029). Yine dren konulan hastalarda daha fazla yara yeri infeksiyonu oluştuğu gözlendi (p=0,008).
Sonuç: L/S BTS yapılan hastalara peroperatif dren uygulanması ile postoperatif dönemde gaz-gaita çıkışı daha erken saatte olmakta ancak abdominal ağrı hissi daha fazla olmaktaydı. Dren uygulaması ile postoperatif erken dönemde boşalan laparoskopi gazının bağırsak hareketlerini olumlu yönde etkilediği kanaatindeyiz.

Anahtar Kelimeler

• Bilateral tubal sterilizasyon
• dren
• laparoskopi

The effect on postoperative bowel movements of intraoperative drain application during laparoscopic bilateral tubal sterilization

Öz

Purpose: The use of a drain during a laparoscopic bilateral tubal sterilization (L/S BTS) operation is not a routine procedure, but enables close follow up of a patient when there is suspected bleeding. The aim of this study was to investigate the potential benefits of drain placement during L/S BTS operation in respect of the gastrointestinal system postoperatively.
Materials and methods: A retrospective evaluation was made of patients applied with L/S BTS at Turhal State Hospital between June 2019 and March 2021. The study included a total of 64 women; 22 applied with a drain during L/S BTS operation and 42 women not applied with a drain. The two groups of patients were compared in respect of age, time to postoperative gas-faeces output, abdominal pain, the formation of intra-abdominal abscess-hematoma, wound site infection, operation time, and time of hospital discharge.
Results: In the comparison of the patients with and without a drain, there was seen to be earlier gas and faeces output in the patients where a drain was used (p=0.003, p=0.018). Greater abdominal pain was felt in the first 12 hours (p=0.029), and a higher rate of wound site infection was observed (p=0.008) in the patients with a drain.
Conclusion: Perioperative placement of a drain in patients applied with L/S BTS was seen to result in earlier gas-faeces output but greater abdominal pain. Drain application in the early postoperative period can be considered to have a positive effect on the bowel movements evacuating laparoscopy gas.

Anahtar Kelimeler

• Bilateral tubal sterilization
• drain
• laparoscopy

Kaynakça

1. 1. Moss C, Isley MM. Sterilization: A Review and Update. Obstet Gynecol Clin North Am. 2015 Dec;42(4):713-724. DOI: 10.1016/j.ogc.2015.07.003
2. 2. Stuart GS, Ramesh SS. Interval Female Sterilization. Obstet Gynecol. 2018 Jan;131(1):117-124. DOI: 10.1097/AOG.0000000000002376
3. 3. Jokinen E, Heino A, Karipohja T, Gissler M, Hurskainen R. Safety and effectiveness of female tubal sterilization by hysteroscopy, laparoscopy, or laparotomy: a register based study. BJOG. 2017 Nov;124(12):1851-1857. DOI: 10.1111/1471-0528.14719
4. 4. Chao TE, Mandigo M, Opoku-Anane J, Maine R. Systematic review of laparoscopic surgery in low- and middle-income countries: benefits, challenges, and strategies. Surg Endosc. 2016 Jan;30(1):1-10. DOI: 10.1007/s00464-015-4201-2
5. 5. Sao CH, Chan-Tiopianco M, Chung KC, Chen YJ, Horng H C, Lee WL et al. Pain after laparoscopic surgery: Focus on shoulder-tip pain after gynecological laparoscopic surgery. J Chin Med Assoc. 2019 Nov;82(11):819-826. DOI: 10.1097/JCMA.0000000000000190
6. 6. Nursal TZ, Yildirim S, Tarim A et al. Effect of drainage on postoperative nausea, vomiting and pain after laparoscopic cholecystectomy. Langenbecks ArchSurg 2003;388:95–100. DOI: 10.1007/s00423-003-0374-6
7. 7. Taş B, Donatsky AM, Gögenur I. Techniques to reduce shoulder pain after laparoscopic surgery for benign gynaecological disease: a systematic review. Gynecol Surg 2013;10:169–175. https://doi.org/10.1007/s10397-013-0791-7
8. 8. Vecchio R, Intagliata E, Marchese S, Battaglia S, Cacciola RR, Cacciola E. Surgical drain after open or laparoscopic splenectomy: is it needed or contraindicated? G Chir. 2015 May-Jun;36(3):101-105. PMCID: PMC4511037

9. 9. Kerimoglu OS, Yilmaz SA, Pekin A, İncesu F, Dogan NU, İlhan T T et al. Effect of drainage on postoperative pain after laparoscopic ovarian cystectomy. J Obstet Gynaecol. 2015 Apr;35(3):287-289. DOI: 10.3109/01443615.2014.948824
10. 10. Chan K, Welsh A, Abbott J. Residual pelvic fluid using two types of drains at laparoscopy: a randomized controlled trial. Obstet Gynecol. 2008 Jun;111(6):1293-1297. DOI: 10.1097/AOG.0b013e31817589cd
11. 11. Abbott J, Hawe J, Srivastava P, Hunter D, Garry R. Intraperitoneal gas drain to reduce pain after laparoscopy: randomized masked trial. Obstet Gynecol. 2001 Jul;98(1):97-100. DOI: 10.1016/s0029-7844(01)01383-7
12. 12. Swift G, Healey M, Varol N, Maher P, Hill D. A prospective randomised double-blind placebo controlled trial to assess whether gas drains reduce shoulder pain following gynaecological laparoscopy. Aust N Z J Obstet Gynaecol. 2002 Aug;42(3):267-270. DOI: 10.1111/j.0004-8666.2002.00267.x
13. 13. Asgari Z, Hosseini R, Rastad H. Does Peritoneal Suction Drainage Reduce Pain After Gynecologic Laparoscopy? Surgical Laparoscopy Endoscopy & Percutaneous Techniques. 2018; 28 (2):73-76. DOI: 10.1097/SLE.0000000000000490
14. 14. Raymond AP, Chan K, Deans R, Bradbury R, Vancaillie TG, Abbott JA. A comparative, single-blind, randomized trial of pain associated with suction or non-suction drains after gynecologic laparoscopy. J Minim Invasive Gynecol. 2010 Jan-Feb;17(1):16-20. http://dx.doi.org/10.1016/j.jmig.2009.04.010
15. 15.Georgiou C, Demetriou N, Pallaris T, Theodosopoulos T, Katsouyanni K, Polymeneas G. Is the routine use of drainage after elective laparoscopic cholecystectomy justified? A randomized trial. J Laparoendosc Adv Surg Tech A. 2011 Mar;21(2):119-123. https://doi.org/10.1089/lap.2010.0003
16. 16. Craciunas L, Stirbu L, Craciunas L, Stirbu L, Tsampras N. The use of a peritoneal gas drain following gynecological laparoscopy: a systematic review. Eur J Obstet Gynecol Reprod Biol 2014 Aug;179:224-228. https://doi.org/10.1038/s41598-021-92762-3
17. 17. Gurer A, Dumlu EG, Dikili E, Kiyak G, Ozlem N. Is a Drain Required after Laparoscopic Cholecystectomy? Eurasian J Med. 2013 Oct;45(3):181-184. DOI: 10.5152/eajm.2013.37
18. 18. Shen CC, Huang FJ, Hsu TY, et al. A prospective, randomized study of closed-suction drainage after laparoscopic-assisted vaginal hysterectomy. The Journal of the American Association of Gynecologic Laparoscopists. 2002; 9 (3):346-352. DOI: 10.1016/s1074-3804(05)60415-x