ZEKAİ SERHAN DERİCİ

Erişkin Hastada Tek Kamera Portu İle Laparoskopik Gastrostomi Post-Operatif Morbidite İlişkili Faktörler ve Sonuçların Açık Gastrostomi Tekniği İle Karşılaştırılması

Amaç: Oral yoldan beslenemeyen hastalar için enteral beslenme mideye yerleştirilen tüp vasıtasıyla yapılabilir. Bu bir Nazogastrik(NG) tüp, cerrahi(açık/laparoskopik) gastrostomi tüpü ya da peruktan endoskopik gastrostomi(PEG) tüpü olabilir. PEG uygulamasının mümkün olmadığı durumlarda cerrahi gastrostomi uygulaması gerekir. Bu makalede tek kamera portu kullanılarak U dikiş tekniği ile laparoskopik yöntemle gastrostomi tüpü yerleştirilen hastalarda post-operatif morbidite ilişkili faktörlerin tartışılması ve sonuçların açık gastrostomi sonuçlarıyla karşılaştırılması amaçlanmıştır. Materyal ve Metot:Dokuz Eylül Üniversitesi Genel Cerrahi Anabilim Dalı’nda tek kamera portu kullanılarak Mart 2014-Mayıs 2018 tarihleri arasında laparoskopik gastrostomi ameliyatı yapılmış 30 ile Ağustos 2010-Temmuz2015 tarihleri arasında açık gastrostomi yapılmış 30 hastanın verileri geriye dönük dosya inceleme yöntemi ile elde edilerek incelendi. Bulgular:Laparoskopik ve açık gastrostomi hastaları için grup için ortanca yaş:62(27-83) & 59,5(19-82). İki grup için de en sık endikasyon: Baş-boyun malignitesi olan hastalarda kapalı ağız-mide pasajı. Ortalama ameliyat süresi: 37,7(±15,1)&75,1(±24,1)dakika. En sık post-operatif komplikasyon Pnömoni:5(%17)&10(%33) hasta, erken post-operatif mortalite: 3(%10)&5(%17)hasta. Komplikasyon ilişkili risk faktörleri: Pre-op NG tüp (OR:13.189) pulmoner enfeksiyon öyküsü(OR:20.848), açık gastrostomi(OR:9,72). Sonuç: Per-oral beslenmenin mümkün olmadığı hastalar için en güvenli beslenme şekli PEG tüpü vasıtasıyla enteral beslenmedir. PEG uygulaması yapılamayan hastalarda cerrahi gastrostomi yapılabilir. Geri dönüşsüz hastalıklarda NG aracılığıyla besleme yaparak uzun süre beklemek yerine özellikle de nozokomiyal pulmoner enfeksiyon gelişmeden gastrostomi yapılması yerinde olacaktır. Morbidite riskini daha da azaltmak için açık cerrahi yerine, oldukça minimal invaziv bir teknik olarak 5mm tek kamera portu ile uygulanan U dikiş laparoskopik gastrostomi tekniği tercih edilebilir.

Objective:Patients who cannot be feed orally should be feed via the gastrostomy catheter. This catheter could be placed as surgical gastrostomy or a percutaneous endoscopic gastrostomy(PEG). Surgical gastrostomy is required when PEG is not possible. In this article, we aimed to discuss the postoperative morbidity-related factors of U suture single camera port laparoscopic gastrostomy operation and compare the results with open gastrostomy procedure. Material and method.All patients were operated in xxx xxx University Department of General Surgery between August 2010 and May 2018. The data of 30 laparoscopic gastrostomy and 30 open gastrostomy patients were analyzed retrospectively. Results.Median age for laparoscopic and open procedure:62(27-83)&59(19-82). The most indication in two group: obstructive head and neck malignancies. Mean operation time:37,7(±15,1)&75,1(±24,1)min. The most post-operative complication: Pneumonia:7(23%)&10(33%). Pneumonia-related mortality:3(10%)&5(17%). The risk factors for complications: Pre-operative NG catheter feeding(OR:13.189), pre-operative medical history of pulmonary infection(OR:20.848) and open gastrostomy (OR:9,72).Conclusion:Parenteral nutrition for a long time increases the risk of morbidity of the patients who cannot be feed per-orally. Feeding via the PEG catheter is the best method for these patients. Patients with unsuccessful PEG attempt need surgical gastrostomy. We have to avoid the long-time NG catheter feeding. Surgical intervention should perform before nosocomial pneumonia occurred for these patients. In these patients, single-camera port laparoscopic gastrostomy technique can be preferred with low morbidity rates, instead of an open approach.

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