Ulus Travma Acil Cerrahi Derg. 2014; 20(1): 28-32 | DOI: 10.5505/tjtes.2014.40359

Laparoskopik apendektomi sýrasýnda apse oluþumunda mikroorganizmalarýn rolü

Melih Akýn¹, Baþak Erginel¹, Abdullah Yýldýz¹, Banu Bayraktar², Fatih Yanar³, Cetin Ali Karadag¹, Nihat Sever¹, Ali Ihsan Dokucu^1
1Þiþli Etfal Eðitim Ve Araþtýrma Hastanesi, Çocuk Cerrahisi Kliniði, Ýstanbul, Türkiye
²Þiþli Etfal Eðitim Ve Araþtýrma Hastanesi, Mikrobiyoloji Kliniði, Ýstanbul, Türkiye
³Ýstanbul Üniversitesi Ýstanbul Týp Fakültesi, Genel Cerrahi Anabilim Dalý, Ýstanbul, Türkiye

AMAÇ: Bu çalýþmada, laparoskopik apandektomi operasyonunun karýniçi enfeksiyon oluþumundaki rolü deðerlendirildi.
GEREÇ VE YÖNTEM: Aðustos 2010-Eylül 2011 arasýnda laparoskopik apandektomi yapýlan 48 çocuk hasta çalýþmaya alýndý. Çalýþmamýz tek merkezli ve prospektif olarak yapýldý. Her hastadan ameliyat sýrasýnda apandektomi öncesi ve sonrasý, aerob ve anaerob olmak üzere dörder adet kültür örneði alýndý. Hastalarýn demografik bilgileri toplandý. Sonuçlar istatistiksel olarak karþýlaþtýrýldý.
BULGULAR: Hastalarýn ortalama yaþý 10.9±3.3 idi, 29’u erkek, 19’u kýzdý. Apendektomi öncesi alýnan 48 aerob kültürün 18’inde üreme oldu (%38), E.coli en sýk üreyen mikroorganizma idi. Apendektomi sonrasý aerob kültürlerin 7’sinde (%15.9) üreme oldu, bakteri sayýsý anlamlý olarak azalmýþtý (p<0.05). Anaerobik kültürlerde ise 48 hastanýn 12’sinde (25%) apandektomi öncesi, 4’ünde (8.3%) ise apendektomi sonrasý üreme oldu. B. fragilis ensýk izole edilen organizma idi. Azalma istatistiksel olarak anlamlý idi (p<0.05).
TARTIÞMA: Bizim sonuçlarýmýz laparoskopik apendektominin karýniçi enfeksiyon riskini, özelikle de aneorop enfeksiyonlarýn riskini artýrmadýðý yönünde idi.

Anahtar Kelimeler: Aerob ve anaerob enfeksiyon, Bacteroides fragilis; Escherichia coli; karýniçi apse; laparoskopik apendektomi.

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Role of dissemination of microorganisms during laparoscopic appendectomy in abscess formation

Melih Akýn¹, Baþak Erginel¹, Abdullah Yýldýz¹, Banu Bayraktar², Fatih Yanar³, Cetin Ali Karadag¹, Nihat Sever¹, Ali Ihsan Dokucu^1
1Department Of Pediatric Surgery, Sisli Etfal Education And Research Hospital,ýstanbul, Turkey
²Department Of Microbiology, Sisli Etfal Education And Research Hospital,ýstanbul, Turkey
³Department Of General Surgery, Ýstanbul University, Istanbul Faculty Of Medicine, Istanbul, Turkey

BACKGROUND: The aim of this study was to investigate the potential contributory role of laparoscopic appendectomy in the occurrence of postoperative intra-abdominal infections.
METHODS: A prospective single-center study including 48 patients who underwent laparoscopic appendectomy was conducted between August 2010 and September 2011. Two peritoneal samples were obtained from each patient in the pre- and post-appendectomy period. Aerobic and anaerobic microbiological cultures were obtained from the samples. The data were analyzed with statistical methods.
RESULTS: The mean age of the 48 patients (29 male, 19 female) was 10.9 years. Among the pre-appendectomy aerobic cultures, microorganisms were isolated in 18 of the patients (38%), with Escherichia coli being the most common. In post-appendectomy aerobic cultures, various bacteria were isolated in 7 patients (14.6%), with the numbers of bacteria statistically significantly reduced (p<0.05). Anaerobic microorganisms were isolated in 12 patients (25%) and 4 patients (8.3%) in pre- and post-appendectomy cultures, respectively, with Bacteroides fragilis the most common organism; there was a significant reduction in the bacterial count (p<0.05). Each patient was regarded as their own control.
CONCLUSION: Our results suggest that laparoscopic appendectomy does not cause an increase in intra-abdominal infections, and particularly not infections associated with anaerobic bacteria.

Keywords: Aerobic and anaerobic infections, Bacteroides fragilis; Escherichia coli; intra-abdominal abscess; laparoscopic appendectomy.

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