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Ürolojik açık cerrahide bir komplikasyon olarak dren tıkanıklığı

Occlusion of the drain as a complication in urologic open surger

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Abstract (2. Language): 
In urological surgery currently, passive or suction drains are routinely used for surgical drainage. In this retrospective study, we reviewed the occlusion of drain developing after open abdominal/retroperitoneal/pelvic operations in which drains were used in the last 3 years. Drain occlusion was detected in only 5 cases (0.97%) in 515 open abdominal/retroperitoneal/pelvic operations in which single drain was used. All patients were male (Mean age=45.2; range=21–67 years). Common features of these cases were the presence of a history of major urological surgery, that they were the cases of training, requirement for the close monitoring of surgical space for possible bleeding and urine leakage, early postoperative hemorrhage, transfusion in all patients, presence of collection in surgical space, occlusion of the whole drain with thrombus and presence of hemorrhagic nature of drain content just prior to this. Silicone flat drain was used in 4 cases, while round drain was used in only 1 case. Drain catheters were changed in 4 patients. Hospitalization period was prolonged and one died in these cases. In conclusion, although occlusion of the drain rarely occurs in urological surgery, it is particularly possible in cases of training, in cases with hemorrhagic diathesis, after major urological, recurrence or anastomotic surgeries, and it might be associated with serious morbidity and mortality. Therefore, one should be cautious in similar cases in terms of this complication, or should be more selective about drain catheter in surgeries with such features.
Abstract (Original Language): 
Günümüz ürolojik cerrahisinde cerrahi drenaj için, rutin olarak pasif ya da emme drenler kullanılır. Bu retrospektif çalışmada, son üç yılda dren kullanılan açık abdominal/retroperitoneal/pelvik ameliyatlardan sonra gelişen dren tıkanıklığını araştırdık. Tek dren kullanılan toplam 515 açık abdominal/retroperitoneal/pelvik ameliyat sonrasında sadece 5 olguda (%0.97) dren tıkanıklığı saptadık. Hastaların tümü erkekti (ortalama yaş=45.2; yaş aralığı=21–67 yıl). Olguların büyük ürolojik ameliyat geçirmiş olmaları, eğitim vakası olmaları, lojun kanama ya da idrar kaçağı nedeniyle yakın takip gerektirmesi, postoperatif erken dönemde kanama olması, tüm hastalarda transfüzyon yapılması, lojda koleksiyon varlığı, tüm dren kateterinin pıhtıyla tıkalı olması ve bunun hemen öncesinde dren içeriğinin hemorajik nitelikte olması ortak özellikler olarak saptandı. Dört olguda silikon düz dren kullanılmışken, sadece bir olguda silikon yuvarlak dren kullanılmıştı. Dört hastada dren kateteri değiştirildi. Bu dört hastada da hospitalizasyon süresi uzamıştı ve 1 hasta eksitus olmuş- tu. Sonuç olarak ürolojik açık cerrahide dren tıkanıklığı nadir olarak görülse de, özellikle eğitim vakalarında, kanama diyatezli olgularda ve büyük ürolojik ameliyatlardan, nüks ya da zor anastomotik cerrahilerden sonra olasıdır ve ciddi morbidite ve mortalite ile birlikte olabilir. Bu nedenle benzer olgularda bu komplikasyon açısından dikkatli olunmalı, ya da bu özelliklere sahip ameliyatlarda dren kateteri konusunda daha seçici olunmalıdır.
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