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Gebelerde Komplike Hemoroidlerin Cerrahi Tedavisi Güvenli mi? 13 Hastanın Retrospektif Analizi ve Literatürün Gözden Geçirilmesi

Year 2019, Volume: 2 Issue: 1, 26 - 32, 30.04.2019

Hakan Yabanoğlu

Abstract

Giriş: Literatürde çok sınırlı sayıda olan; gebelerde komplike hemoroidlerde cerrahi tedavinin güvenli olup olmadığını belirlemek amacı ile kliniğimizde gebelik sürecinde cerrahi tedavi uygulanan hastaların tedavi sonuçlarını sunmayı amaçladık.

Gereç ve Yöntemler: Ocak 2011 ve Nisan 2018 yılları arasında hemoroid cerrahisi uygulanan hastaların dosyaları geriye dönük olarak incelendi. Konservatif ve/veya medikal tedaviden fayda görmeyen hastaların yaş, gebelik ayı, daha önceden hemoroidal hastalık ve anorektal cerrahi öyküsü, başvuru şikayeti, ek hastalıkların varlığı, vücut kitle indeksi, daha önce medikal tedavi alıp almadığı, fizik inceleme bulguları, kolonoskopi/rektoskopi sonuçları, eşlik eden diğer anorektal bölge hastalıkları, yapılan ameliyat tekniği, komplikasyon varlığı, hastanede kalış süresi, kontrol muayenesi ve tedavi sonuçları kayıt altına alındı.

Sonuç: Hemoroid cerrahisi uygulanan kadın hastaların 13 (%17.8)' ü gebe idi. Hastaların 8 (%61.5)' i 3. trimesterde, 4 (%30.7)' ü 2. trimesterde ve 1 (%7.6)' i 1. trimesterde idi. En sık başvuru şikayeti ağrı ve kanama idi. Ortalama yaş 30 (20-40) yıl ve vücut kitle indeksleri 27 (23-36) kg/m2idi. Hastaların 9 (%69.2)' na hemoroidektomi (milligan morgan veya ferguson tekniği ile), 2 (%15.3)' ne hemoroidektomi ve sfinkterotomi, 1 (%7.6) 'e hemoroidopeksi ve 1 (%7.6)' ne trombektomi uygulandı. Ortalama ameliyat süresi 30 (10-35) dk ve hastanede kalış süresi 2 (1-3) gün idi. Erken dönemde 11 (%84.6) hastada ağrı ve 1 (%7.6) ileus tablosu görüldü. Hastalarımızda erken ve geç dönemde başka komplikasyon olmadı. 

Tartışma: Gebelik sürecinde oldukça sık görülen hemoroidal hastalığın öncelikli tedavisi medikal ve konservatif yöntemler olmalıdır. Ancak akut hemoroidal hastalığın varlığında; yeterli cerrahi, anestezi ve teknik olanaklara sahip merkezlerde hemoroidal cerrahi düşük komplikasyon oranları ile uygulanabilmektedir.


Keywords

Hemoroid Gebelik Hemoroidektomi

References

  • 1. Füzün M. Anorektal Benign Hastalıklar. Klinik Gastroenteroloji ve Hepatoloji. 2007
  • 2. Place R, Hyman N, Simmang C, Cataldo P, Church J, Cohen J, et al. The standart task force the ASCRS. Dis Colon Rectum. 2003;46:573-6.
  • 3. Creasy RK, Resnik R. Maternal fetal medicine. Philadelphia: WB saunders; 1984.
  • 4. Wolff BG. Pemberton JH, Wexner SD, Fleshman JW. Hemoroidal Disease. The ASCRS Textbook of Colon and Rektal Surgery. 2007.
  • 5. Avsar AF, Keskin HL. Haemorrhoids during pregnancy. J Obstet Gynaecol. 2010 Apr; 30(3):231-7. doi: 10.3109/01443610903439242.
  • 6. Mirhaidari SJ, Porter JA, Slezak FA. Thrombosed external hemorrhoids in pregnancy: a retrospective review of outcomes. Int J Colorectal Dis. 2016 Aug;31(8):1557-9. doi: 10.1007/s00384-016-2565-y.
  • 7. Gojnic M, Dugalic V, Papic M, Vidakovic S, Milicevic S, Pervulov M. The significanceof detailed examination of hemorrhoids during pregnancy. Clin Exp Obstet Gynecol. 2005; 32(2):183-4.
  • 8. Poskus T, Buzinskienė D, Drasutiene G, Samalavicius NE, Barkus A, Barisauskiene A, et al. Haemorrhoids and anal fissures during pregnancy and after childbirth: a prospective cohort study. BJOG. 2014 Dec;121(13):1666-71. doi: 10.1111/1471-0528.12838.
  • 9.Calhoun BC. Gastrointestinal disorders in pregnancy. Obstet Gynecol Clin North Am.1992;19(4). p. 733-44.
  • 10. Hussain JN. Hemorrhoids. Prim Care. 1999; 26:35-51.
  • 11. Hodes B. Hemorrhoidal Products. In: Handbook of Nonprescription Drugs, 11th ed. American Pharmaceutical Association. Washington D.C. 1996.
  • 12. Ho YH, Foo CL, Seow-Choen F, Goh HS. Prospective randomized controlled trial of a micronized flavonidic fraction to reduce bleeding after haemorrhoidectomy. British Journal of Surgery. 1995;82:1034–1035.
  • 13. Shanmugam V, Thaha MA, Rabindranath KS, Campbell KL, Steele RJ, Loudon MA. Rubber band ligation versus excisional haemorrhoidectomy for haemorrhoids. Cochrane Database Syst Rev. 2005;20;CD005034.
  • 14. Halverson A. Hemorrhoids. Clin Colon Rectal Surg. 2007;20:77–85.
  • 15. Saylam B, Özer MV, Polat Düzgün A, Dinç T, Gülseren MO, Coşkun F. The Milligan-Morgan operation in the surgical treatment of hemorrhoids: Survey of 828 cases. Ulusal Cerrahi Dergisi. 2011; 27(1): 31-34. DOI: 10.5097/1300-0705.UCD.761-11.02
  • 16. Longo A. Treatment of hemorrhoidal disease by reduction of mucosa and hemorrhoidal prolapse with a circular suturing device: a new procedure. Sixth World Congress of Endoscopic Surgery. Rome, Italy. Bologna: Monduzzi Publishing Co; 1998. p. 777-84.
  • 17. Jayaraman S, Colquhoun PH, Malthaner RA. Stapled hemorrhoidopexy is associatedwith a higher long-term recurrence rate of internal hemorrhoids compared withconventional excisional hemorrhoid surgery. Dis Colon Rectum. 2007;50:1297–1305.
  • 18. Lan P, Wu X, Zhou X, Wang J, Zhang L. The safety and efficacy of stapled hemorrhoidectomy in the treatment of hemorrhoids: a systematic review and metaanalysis of ten randomized control trials. Int J Colorectal Dis. 2006;21:172–178.
  • 19. Shao WJ, Li GC, Zhang ZH, Yang BL, Sun GD, Chen YQ. Systematic review and meta-analysis of randomized controlled trials comparing stapled haemorrhoidopexy with conventional haemorrhoidectomy. Br J Surg. 2008;95:147–160.

Year 2019, Volume: 2 Issue: 1, 26 - 32, 30.04.2019

Hakan Yabanoğlu

Abstract

References

  • 1. Füzün M. Anorektal Benign Hastalıklar. Klinik Gastroenteroloji ve Hepatoloji. 2007
  • 2. Place R, Hyman N, Simmang C, Cataldo P, Church J, Cohen J, et al. The standart task force the ASCRS. Dis Colon Rectum. 2003;46:573-6.
  • 3. Creasy RK, Resnik R. Maternal fetal medicine. Philadelphia: WB saunders; 1984.
  • 4. Wolff BG. Pemberton JH, Wexner SD, Fleshman JW. Hemoroidal Disease. The ASCRS Textbook of Colon and Rektal Surgery. 2007.
  • 5. Avsar AF, Keskin HL. Haemorrhoids during pregnancy. J Obstet Gynaecol. 2010 Apr; 30(3):231-7. doi: 10.3109/01443610903439242.
  • 6. Mirhaidari SJ, Porter JA, Slezak FA. Thrombosed external hemorrhoids in pregnancy: a retrospective review of outcomes. Int J Colorectal Dis. 2016 Aug;31(8):1557-9. doi: 10.1007/s00384-016-2565-y.
  • 7. Gojnic M, Dugalic V, Papic M, Vidakovic S, Milicevic S, Pervulov M. The significanceof detailed examination of hemorrhoids during pregnancy. Clin Exp Obstet Gynecol. 2005; 32(2):183-4.
  • 8. Poskus T, Buzinskienė D, Drasutiene G, Samalavicius NE, Barkus A, Barisauskiene A, et al. Haemorrhoids and anal fissures during pregnancy and after childbirth: a prospective cohort study. BJOG. 2014 Dec;121(13):1666-71. doi: 10.1111/1471-0528.12838.
  • 9.Calhoun BC. Gastrointestinal disorders in pregnancy. Obstet Gynecol Clin North Am.1992;19(4). p. 733-44.
  • 10. Hussain JN. Hemorrhoids. Prim Care. 1999; 26:35-51.
  • 11. Hodes B. Hemorrhoidal Products. In: Handbook of Nonprescription Drugs, 11th ed. American Pharmaceutical Association. Washington D.C. 1996.
  • 12. Ho YH, Foo CL, Seow-Choen F, Goh HS. Prospective randomized controlled trial of a micronized flavonidic fraction to reduce bleeding after haemorrhoidectomy. British Journal of Surgery. 1995;82:1034–1035.
  • 13. Shanmugam V, Thaha MA, Rabindranath KS, Campbell KL, Steele RJ, Loudon MA. Rubber band ligation versus excisional haemorrhoidectomy for haemorrhoids. Cochrane Database Syst Rev. 2005;20;CD005034.
  • 14. Halverson A. Hemorrhoids. Clin Colon Rectal Surg. 2007;20:77–85.
  • 15. Saylam B, Özer MV, Polat Düzgün A, Dinç T, Gülseren MO, Coşkun F. The Milligan-Morgan operation in the surgical treatment of hemorrhoids: Survey of 828 cases. Ulusal Cerrahi Dergisi. 2011; 27(1): 31-34. DOI: 10.5097/1300-0705.UCD.761-11.02
  • 16. Longo A. Treatment of hemorrhoidal disease by reduction of mucosa and hemorrhoidal prolapse with a circular suturing device: a new procedure. Sixth World Congress of Endoscopic Surgery. Rome, Italy. Bologna: Monduzzi Publishing Co; 1998. p. 777-84.
  • 17. Jayaraman S, Colquhoun PH, Malthaner RA. Stapled hemorrhoidopexy is associatedwith a higher long-term recurrence rate of internal hemorrhoids compared withconventional excisional hemorrhoid surgery. Dis Colon Rectum. 2007;50:1297–1305.
  • 18. Lan P, Wu X, Zhou X, Wang J, Zhang L. The safety and efficacy of stapled hemorrhoidectomy in the treatment of hemorrhoids: a systematic review and metaanalysis of ten randomized control trials. Int J Colorectal Dis. 2006;21:172–178.
  • 19. Shao WJ, Li GC, Zhang ZH, Yang BL, Sun GD, Chen YQ. Systematic review and meta-analysis of randomized controlled trials comparing stapled haemorrhoidopexy with conventional haemorrhoidectomy. Br J Surg. 2008;95:147–160.
There are 19 citations in total.

Details

Primary Language English
Subjects Surgery
Journal Section Articles
Authors

Hakan Yabanoğlu

Publication Date April 30, 2019
Acceptance Date April 29, 2019
Published in Issue Year 2019 Volume: 2 Issue: 1

Cite

APA Yabanoğlu, H. (2019). Gebelerde Komplike Hemoroidlerin Cerrahi Tedavisi Güvenli mi? 13 Hastanın Retrospektif Analizi ve Literatürün Gözden Geçirilmesi. Journal of Cukurova Anesthesia and Surgical Sciences, 2(1), 26-32.
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