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

Yıl 2017, Cilt: 8 Sayı: 4, 191 - 197, 15.12.2017

Ahmet Ertürk , İbrahim Karaman , Ayşe Karaman , Engin Yılmaz Çağatay Evrim Afşarlar Derya Erdoğan , Yusuf Hakan Çavuşoğlu , Özlem Balcı , İsmet Faruk Özgüner

https://doi.org/10.18663/tjcl.354248

Öz

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. 

Anahtar Kelimeler

Postoperative adhesion, intestinal obstruction, child, newborn

Laparotomi yapılan hastalarda brid ileus risk faktörleri ve tedavi yaklaşımlarının değerlendirilmesi

Öz

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

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