ÖZET

Amaç:

Rektal cerrahide aşağı anastomozlardan dolayı oluşan peri-anastomotik poşların konservatif tedavisi, hastalarda generalize peritonit bulguları olmadığı durumlarda mümkündür. Çalışmamızda bu tür komplikasyonların Endo-SPONGE^® ve transrektal endoskopik yıkama ile tedavisini tanımlamaktadır.

Yöntemler:

Rektal rezeksiyon sonrası anastomoz kaçağından abse gelişen 16 hasta retrospektif olarak incelendi, bunlardan 9’u endoskopik transrektal yıkama ve diğer 7 hastada endoskopik vakum yöntemi ile tedavi edildi.

Bulgular:

On üç hastaya ilk ameliyat esnasında loop ileostomi uygulandı, 3 hastaya ise anastomoz kaçağı gözlendikten sonra saptırıcı stoma yapıldı. Ortalama abse kavitesi hacmi EndoVAC (vakum yardımlı kapama) ile tedavi edilen grupta 82,6 82,6 cc (24,7-128) ve endoskopik yıkama grubunda ise 33,3 (10,5-61,1) cc idi. Değiştirilen sponge (sünger) sayısı 13,8 (5-25) ve poşun kapanması için gereken süre negatif aspirasyon grubu için ortalama 74,3 (20-136) gün ve transrektal endoskopik yıkama grubunda da 66,1 (30-210) gün idi. Geç anastomoz komplikasyonu olarak, Endo-SPONGE^® ile tedavi edilen 7 hastadan yalnızca birinde (%14,2) darlık kaydedilirken konservatif endoskopik yıkama grubundaki 9 hastadan 4’ünde (%44,4) reoperasyona gerek gösteren darlık gelişmiştir.

Sonuç:

Deneyimlerimize göre sponge yerleştirilmesi ve negatif basınçlı aspirasyon, rektal kanser için yapılan aşağı anterior rezeksiyon sonrası anastomoz kaçağı tedavisinde yararlı olabilir. Kavitenin kapanma süresi sonuçları konvansyonel tedaviye göre kötü değildir, fonksiyonel avantaj konvansyonel tedaviye üstün larak izlendi. Endo-SPONGE^® yerleştirilen hastalar daha az darlık ve defekasyon problemine sahiptir.

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Rektum Rezeksiyon Sonrası Gelişen Anastomoz Kaçaklarına Bağlı Perianastomotik Poşlara Yaklaşım

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References