Laparoskopik sleeve gastrektomi hastalarımızın erken ve geç komplikasyonlarına yaklaşımımız

Yıl 2022, , 738 - 744, 01.10.2022

Ali Kemal Taşkın , Mehmet Akif Üstüner

https://doi.org/10.31362/patd.1104945

Öz

Giriş: Laparaskopik Sleeve Gastrektomi (LSG) morbid obezite tedavisinde etkili bir cerrahi yöntem olarak kullanılmaktadır. Çalışmamızda LSG yaptığımız hastalarımızın erken ve geç dönem komplikasyonlarını ve tedavi yöntemlerini araştırdık.
Gereç ve yöntem: Ocak 2016-Aralık 2020 yıllarında 18-70 yaş arası opere edilen 390 hasta çalışmaya dahil edildi. Hasta kayıtları retrospektif olarak elektronik ortamdan taranarak kayıt edildi.
Bulgular: Morbid obezite olan 390 hastaya Laparoskopik sleeve gastrektomi (LSG) cerrahisi uygulandı. Hastaların 310’u (%78,1) kadın, 80’i (%21,9) erkek, yaş ortalamaları 42,1 (22-65) ve 42,9 (24-70) idi. LSG olan hastaların 22’sinde (%5,64) komplikasyon gözlendi. Hastaların 10’unda (%2,56) erken dönemde komplikasyon, 9’unda (%2,30) geç dönemde komplikasyon gelişirken, 3(%0,76)’ünde hem erken hem de geç dönemde komplikasyon geliştiği tespit edildi.
Erken dönem komplikasyonlar; Yedi (%1,8) hastada postoperatif erken dönem anostomoz kaçağı, 1 (%0,25) hastada kanama, 2 (%0,5) hastada atelektazi, 1 (%0,25) hastada dehidratasyon, 1 (%0,25) hastada karın içi koleksiyon,1 (%0,25) hastada plörozi tespit edildi. Kaçak hastalarına stent uygulandı, kanama gözlenen hasta opere edildi. Diğer hastalara medikal tedavi uygulandı.
Geç dönem komplikasyonlar; 5 (%1,28) hastada insisura angulariste reflüye sebeb olan minimal darlık, 4 (%1,02) hastada trokar yeri hernisi olduğu tespir edildi.
Erken ve geç komplikasyon; Erken dönemde kaçak nedeniyle stent uygulanan 3 (%0,76) hastada aynı zamanda geç dönem komplikasyonu da gelişti. Bu hastaların 1 (%0,25)‘inde stent sonrası geç pilor stenozu, 1 (%0,25)‘inde mide ülserleri ve birinde de 1 (%0,25) özofagokardial bileşkede darlık tespit edildi. Trokar yeri hernisi olan hastalar ve ciddi semptomlu insisura angularis darlığı olan hasta cerrahi olarak tedavi edilirken, diğer hastalar medikal tedavi uygulandı. Mortalite gözlenmedi.
Sonuç: Morbid obezite tedavisinde etkili bir yöntem olan LSG’nin erken ve geç dönemde gözlenebilecek ciddi komplikasyonları olabilir. Bu nedenle gerekli yoğun bakım koşulları ve stent gibi endoskopik girişimlerin hızlı ve güvenilir bir şekilde yapılabileceği merkezlerde opere edilmeleri daha güvenli olacağı kanısındayız.

Anahtar Kelimeler

Laparoskopik sleeve gastrektomi, kaçak, stent, komplikasyon

Destekleyen Kurum

DESTEKLEYEN KURUM BULUNMAMAKTADIR.

Proje Numarası

YOKTUR.

Teşekkür

Sayın hocam, kolay gelsin , şimdiden elinize sağlık...

Our approach to early and late complications of laparoscopic sleeve gastrectomy patients

Öz

Aim: Laparoscopic Sleeve Gastrectomy (LSG) is used as an effective surgical method in the treatment of morbid obesity. In our study, we investigated the early and late complications and treatment methods of our patients who underwent LSG.
Material and method: 390 patients between the ages of 18-70 who were operated between January 2016 and December 2020 were included in the study. Patient records were retrospectively scanned electronically and the results were recorded.
Results: Laparoscopic sleeve gastrectomy surgery was performed on 390 morbidly obese patients. Of the patients, 310 (78.1%) were female, 80 (21.9%) were male, with a mean age of 42.1 years (22-65) and 42.9 years (24-70) patients. Complications were observed in 22 (5.64%) patients with LSG. Ten (2.56%) of the patients developed complications in the early period, 9 (2.33%) developed complications in the late period, and 3 (0.75%) of them developed both early and late complications.
Early complications; Postoperative early anastomosis leakage in 4 (1%) patients, atelectasis in 2 (0.5%) patients, bleeding in 1 (0.25%) patient, dehydration in 1 (0.25%) patient, intra-abdominal collection in 1 (0.25%) patient, pleurosis in 1 (0.25%) patient was detected. Stent was applied to the patients with leakage, and the patient with bleeding was operated. Other patients received medical treatment.
Late complications; Minimal stenosis causing reflux in the incisura angularis was found in 5 (1.25%) patients, and trocar port hernia was found in 4 (1%) patients.
Early and late complication; Late complications were also observed in 3 (0.75%) patients who underwent stenting due to early leakage. Late pyloric stenosis was detected in 1 (0.25%) of these patients, gastric ulcers in 1 (0.25%) and esophagocardial stenosis in 1 (0.25%) patient. Patients with trocar port hernia and patients with severe symptomatic incisura angularis stenosis were treated surgically, while other patients were treated medically. No mortality was observed.
Conclusion: Laparoscopic sleeve gastrectomy, which is an effective method in the treatment of morbid obesity, can have serious early and late complications. For this reason, we believe that it will be safer to operate them in centers where necessary intensive care conditions and endoscopic interventions such as stenting can be performed quickly and reliably.

Anahtar Kelimeler

Laparoscopic sleeve gastrectomy, leak, stent, complication

Proje Numarası

YOKTUR.

Kaynakça

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