| Abstract | Cilj istraživanja: Cilj ove retrospektivne, monocentrične studije bio je usporediti sigurnost i učinkovitost triklosanom obloženog polidioksannskog (PDS) konca u odnosu na neobloženi u prevenciji kirurških infekcija u djece operirane zbog hipospadije.
Ispitanici i metode: U studiju je uključeno 550 bolesnika operiranih zbog hipospadije u razdoblju od 1. siječnja 2014. do 31. prosinca 2023. godine. Bolesnici su retrospektivno podijeljeni u dvije skupine, ovisno o vrsti konca koja je korištena. U prvu skupinu su svrstana 262 bolesnika u kojih je korišten neobloženi konac (PDS II), dok je preostalih 288, u kojih je korišten obloženi konac (PDS Plus), činilo drugu skupinu. Primarni cilj bio je usporediti učestalost kirurških infekcija među skupinama, dok su sporedni ciljevi bili usporediti stopu ranih i kasnih komplikacija, broj ponovnih prijema u bolnicu te broj ponovnih operacija. Svim bolesnicima su zabilježeni i uspoređeni demografski i navedeni klinički podatci.
Rezultati: Medijan dobi svih bolesnika uključenih u studiju iznosio je 16 (interkvartilni raspon, IQR 14, 20) mjeseci. Skupina u kojoj je korišten PDS Plus konac pokazala je značajno nižu stopu kirurških infekcija u usporedbi sa skupinom u kojoj je korišten PDS II (n=18 (6,9%) naspram n=4 (1,4%), P<0,001). Infekcija je dovela do dehiscijencije u 10 od 18 bolesnika u kojih je korišten PDS II te u sva četiri bolesnika iz PDS Plus skupine (P=0,07). Broj poslijeoperacijskih fistula također je bio značajno niži u skupini u kojoj je korišten PDS Plus konac (13,7% naspram 8,3%, P=0,042). Stopa kasnih komplikacija nije se razlikovala među skupinama: meatalna stenoza (P=0,944); zaostala korda (P=0,107); striktura uretre (P=0,196); ožiljak (P=0,351); poteškoće mokrenja (P=0,713). Nije bilo zabilježenih slučajeva neplaniranog povratka u operacijsku salu ni u jednoj skupini. Stopa ponovnih prijema u bolnicu bila je niska u obje skupine (n=5 (1,9%) naspram n=2 (0,6%), P=0,266), dok je broj ponovnih operacija bio značajno niži u bolesnika u kojih je korišten PDS Plus konac (11,1% naspram 20,6%, P=0,03).
Zaključci: Korištenje triklosanom obloženog konca smanjuje stopu kirurških infekcija, poslijeoperacijskih fistula i broj ponovnih operacija te se zbog toga može smatrati sigurnom i učinkovitom opcijom u liječenju hipospadije u djece. |
| Abstract (english) | Objectives: The aim of this retrospective, single-center study was to evaluate safety and effectiveness of triclosan-coated PDS and uncoated PDS in preventing surgical site infection in pediatric patients operated on for hypospadias.
Patients and methods: A total of 550 patients who underwent hypospadias repair surgery in the period from January 1, 2014 to December 31, 2023, were enrolled in the study. The patients were retrospectively split into two study groups, based on the type of suture used. The patients in which uncoated polydioxanone (PDS II) was used, 262 of them, made the first group, while the remaining 288, in which triclosan-coated polydioxanone (PDS Plus) was used, made the second group. Primary outcome was to compare the frequency of surgical site infections between the groups, while additional outcomes were the rates of other complications, the number of repeat admissions and repeat operations. All patients' demographic and clinical data were recorded and compared.
Results: The patients enrolled in the study had the median age of 16 (IQR 14, 20) months. The group in which PDS Plus suture was used showed a significantly lower rate of surgical infections compared to the group in which PDS II was used (n=18 (6.9%) vs. n=4 (1.4%), P<0.001). In 10 out of 18 patients in whom PDS II was used and in all four patients from the PDS Plus group, the infection caused dehiscence (P=0.07). The rate of postoperative fistulas was also found to be lower in the PDS Plus group (13.7% vs. 8.3%, P=0.042). The rate of late complications was almost the same in both groups: stenosis of meatus (P=0.944); residual penile curvature (P=0.107); stricture of urethra (P=0.196); scar formation (P=0.351); urinary system discomfort (P=0.713). No cases of unplanned return to the operating room were recorded in any of the groups. The rate of readmissions to the hospital was low in both groups (n=5 (1.9%) vs. n=2 (0.6%), P=0.266), while the number of repeat operations was significantly lower in the group in which PDS Plus suture was used (11.1% vs. 20.6%, P=0.03).
Conclusions: The study showed that the use of triclosan-coated sutures reduces the frequency of surgical site infections, postoperative fistulas and the number of repeat operations, and therefore it can be considered as a safe and effective option in the treatment of hypospadias in children. |
