Ostomi kapatılan hastalarda negatif basınçlı insizyon yönetim sistemi kullanımının etkinliği

Yıl 2021, Cilt: 12 Sayı: 4, 379 - 384, 22.12.2021

Ramazan Topcu İsmail Sezikli Murat Kendirci İbrahim Tayfun Şahiner

https://doi.org/10.18663/tjcl.971133

Öz

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

Destekleyen Kurum

yok

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

Öz

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.

Anahtar Kelimeler

Stoma, Negative pressure incision closure method, Wound infection

Kaynakça

• 1. Klink CD, Wunschmann M, Binnebosel M, et al. Influence of skin closure technique on surgical site infection after loop ileostomy reversal: retrospective cohort study. Int J Surg. 2013; 11: 1123–5.
• 2. Milanchi S, Nasseri Y, Kidner T, et al. Wound infection after ileostomy closure can be eliminated by circumferential subcuticular wound approximation. Dis Colon Rectum. 2009; 52: 469–74.
• 3. Vermulst N, Vermeulen J, Hazebroek EJ, et al. Primary closure of the skin after stoma closure—management of wound infections is easy without (long-term) complications. Digest Surg. 2006; 23: 255–8.
• 4. Zimlichman E, Henderson D, Tamir O, et al. Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA Intern Med. 2013; 173.
• 5. de Lissovoy G, Fraeman K, Hutchins V,et al. Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control. 2009; 37 :387-97.
• 6. Wick EC, Vogel JD, Church JM, et al. Surgical site infections in a “high outlier” institution: are colorectal surgeons to blame? Dis Colon Rectum. 2009; 52 :374-9.
• 7. Gheorghe A, Moran G, Duffy H,et al. Health utility values associated with surgical site infection: a systematic review. Value Health. 2015; 18 :1126-37.
• 8. Murray BW, Cipher DJ, Pham T, et al. The impact of surgical site infection on the development of incisional hernia and small bowel obstruction in colorectal surgery. Am J Surg. 2011; 202 :558-60.
• 9. Anthony T, Murray BW, Sum-Ping JT, et al. Evaluating an evidence-based bundle for preventing surgical site infection: a randomized trial. Arch Surg. 2011; 146 :263-9.
• 10. Ploegmakers IB, Olde Damink SW, et al. Alternatives to antibiotics for prevention of surgical infection. Br J Surg. 2017; 104: 24-33.
• 11. Pastor C, Artinyan A, Varma MG,et al. An increase in compliance with the Surgical Care Improvement Project measures does not prevent surgical site infection in colorectal surgery. Dis Colon Rectum. 2010; 53 :24-30.
• 12. Aimaq R, Akopian G, Kaufman HS. Surgical site infection rates in laparoscopic versus open colorectal surgery. Am Surg. 2011; 77 :1290-4.
• 13. Schwenk W, Haase O, Neudecker J,et al. Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev. 2005.
• 14. Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg 1997; 38: 563–76.
• 15. Strugala V, Martin R. Meta-Analysis of Comparative Trials Evaluating a Prophylactic Single-Use Negative Pressure Wound Therapy System for the Prevention of Surgical Site Complications. Surg Infect (Larchmt). 2017; 18 :810-9.
• 16. O'Leary DP, Peirce C, Anglim B, et al. Prophylactic Negative Pressure Dressing Use in Closed Laparotomy Wounds Following Abdominal Operations: A Randomized, Controlled, Open-label Trial: The P.I.C.O. Trial. Ann Surg. 2017; 265: 1082-6.
• 17. Pemmaraju VT, Lansing SS, Husain S. A protocol for skin closure after stoma reversal. Tech Coloproctol. 2020; 24: 255–7.
• 18. Fernandez R, Griffiths R. Water for wound cleansing. Cochrane Database Syst Rev. 2008.
• 19. Wackenfors A, Gustafsson R, Sjogren J, et al. Blood flow responses in the peristernal thoracic wall during vacuum-assisted closure therapy. Ann Thorac Surg. 2005; 79: 1724–31.
• 20. Morykwas MJ, Argenta LC, Shelton-Brown EI,et al. Vacuumassisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg. 1997; 38: 553–62.
• 21. Wackenfors A, Sjogren J, Gustafsson R, et al. Effects of vacu-massisted closure therapy on inguinal wound edge microvascular blood flow.Wound Repair Regen. 2004; 12: 600–6.
• 22. Brinkert D, Ali M, Naud M, et al. Negative pressure wound therapy with saline instillation: 131 patient case series. Int Wound J. 2013; 10: 56–60.
• 23. Fluieraru S, Bekara F, Naud M, et al. Sterile-water negative pressure instillation therapy for complex wounds and NPWT failures. J Wound Care. 2013; 22: 293–9.
• 24. Gupta S, Gabriel A, Lantis J, Téot L. Clinical recommendations and practical guide for negative pressure wound therapy with instillation. Int Wound J. 2016; 13: 159–74.
• 25. Cantero R, Rubio-Perez I, Leon M, et al. Negative-pressure therapy to reduce the risk of wound infection following diverting loop ileostomy reversal: an initial study. Adv Skin Wound Care. 2016; 29: 114–8.
• 26. Poehnert D, Hadeler N, Schrem H, et al. Decreased superficial surgical site infections, shortened hospital stay, and improved quality of life due to incisional negative pressure wound therapy after reversal of double loop ileostomy. Wound Repair Regen. 2017; 25: 994–1001.
• 27. Semsarzadeh NN, Tadisina KK, Maddox J, et al. Closed incision negative-pressure therapy is associated with decreased surgicalsite infections: a meta-analysis. Plast Reconstr Surg 2015; 136 : 592– 602.
• 28. Li PY, Yang D, Liu D, et al. Reducing surgical site infection with negative-pressure wound therapy after open abdominal surgery: a prospective randomized controlled study. Scand J Surg 2017; 106: 189– 95.
• 29. Blackham AU, Farrah JP, McCoy TP, et al. Prevention of surgical site infections in high-risk patients with laparotomy incisions using negative-pressure therapy. Am J Surg 2013; 205 : 647– 54.