Ulus Travma Acil Cerrahi Derg. 2013; 19(3): 189-194 | DOI: 10.5505/tjtes.2013.63444

Bakteriyel Peritonitte Antibiyotikle Lavajýn Adezyonu Önlemede Etkisi

Huseyin Ayhan Kayaoglu¹, Namik Ozkan¹, Erdinc Yenidogan¹, Resid Dogan Koseoglu^2
1Gaziosmanpaþa Üniversitesi Týp Fakültesi, Genel Cerrahi Anabilim Dalý, Tokat
²Gaziosmanpaþa Üniversitesi Týp Fakültesi, Patoloji Anabilim Dalý, Tokat

Amaç: Ýntraabdominal yapýþýklýklar halen ciddi bir problemdir. Geçmiþte septik batýnda adezyon formasyonunu önlemek için sadece rifamisin lavajý denenmistir. Bu çalýþmanýn amacý abdominal sepsis modelinde farklý antibiyotiklerin intraperitoneal uygulamasýnýn etkinliðini deðerlendirmektir.
Gereç ve Yöntem: 60 adet Wistar-albino sýçan rastgele olacak þekilde 6 eþit gruba ayrýlmýþtýr. Tüm gruplara çekal ligasyon ve puncture modeli uygulanarak bakteriyel peritonit oluþturulmuþtur. Grup 1 kontrol grubudur. Grup 2’ye izotonik salinle, grup 3’e imipenemle, grup 4’e seftriaksonla, grup 5’e sefazolinle ve grup 6’ya metronidazolle periton lavajý yapýlmýþtýr. Cerrahiden 4 hafta sonra intraabdominal adezyonlar deðerlendirilmiþ, adezyonlarýn gerginlik kuvveti ölçülmüþ ve histopatolojik deðerlendirme yapýlmýþtýr.
Bulgular: Ýmipenem, seftriakson ve sefazolin ile adezyon formasyonu anlamlý derecede azalmýþ (p<0,001) ve fibrozis skorlarý anlamlý derecede düþük olarak bulunmuþtur (p=0,013). En kötü adezyon metronidazol grubunda izlenmiþtir. Adezyon kopma kuvveti grup 4 ve 5’te anlamlý olarak düþüktür (p<0,001). Ýnflamasyon daðýlým skorlarý benzer olmasýna raðmen (p=0,058) grade 3 inflamasyon skorlarý sadece kontrol, salin ve metronidazol grubunda gözlemlenmiþtir.
Sonuç: Bu veriler ýþýðýnda septik karýnda sefalosporinle peritoneal lavajýn adezyon formasyonunu önlenmede etkin olduðu ve sonuçlarýn bir klinik çalýþmada deðerlendirilmesi gerektiði söylenebilir.

Anahtar Kelimeler: Peritoneal lavaj, intraabdominal adezyon, antibiyotik, sefazolin, seftriakson, imipenem, metronidazol

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Effect of Antibiotic Lavage in Adhesion Prevention in Bacterial Peritonitis.

Huseyin Ayhan Kayaoglu¹, Namik Ozkan¹, Erdinc Yenidogan¹, Resid Dogan Koseoglu^2
1Department Of General Surgery, Gaziosmanpasa University, Faculty Of Medicine, Tokat, Turkey
²Department Of Pathology, Gaziosmanpasa University, Faculty Of Medicine, Tokat, Turkey

Background: Intraabdominal adhesions are still a major problem. Previously, only rifamycin lavage was tried to prevent adhesion formation in septic abdomen. The aim of our study was to test the effectiveness of intraperitoneal application of different antibiotics in an abdominal sepsis model.
Materials and methods: 60 Wistar-albino rats were randomly divided into 6 equal groups. Bacterial peritonitis was induced using caecal ligation and puncture model in all groups. Group 1 was control. Peritoneum was lavaged with isotonic saline in group 2, with imipenem in group 3, with ceftriaxone in group 4, with cefazolin in group 5 and with metronidazole in group 6. Four weeks after the surgery, intraabdominal adhesions were graded, tensile strength of the adhesions was measured and histopathological examinations were performed.
Results: Imipenem, ceftriaxone and cefazolin significantly reduced adhesion formation (p<0.001) with significantly low fibrosis scores (p=0.013). Worst adhesions were in metronidazole group. Breaking force of adhesions was significantly low in group 4 and 5 (p<0.001). Although, the distribution of inflammation scores were similar (p= 0.058), grade 3 inflammation scores were only seen in control, saline and metronidazole groups.
Conclusion: According to these data, cephalosporins seem effective to prevent adhesion formation in septic abdomens and need to be evaluated in a clinical trial.

Keywords: Peritoneal lavage, intraabdominal adhesion, antibiotic, cefazolin, ceftriaxone, imipenem, metronidazole

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