Ahmet DİRİCAN, Sabri ERGÜNEY, Süphan ERTÜRK, Yılmaz ERSAN, Yusuf ÇİÇEK, Ramazan KUŞASLAN

Dumping sendromu (DS) ve birlikte olan alkalen reflü gastrit sendromu (ARGS) için düzeltici ameliyatlar

Dumping sendromu ve dumping sendromu ile birlikte olan alkalen reflü gastrit sendromu için çok sayıda farklı düzeltici ameliyat tarif edilmiştir. Bu ameliyatların nisbi etkinliğini mukayese eden kontrollü çalışmalar yoktur. Onların etkinliğinin analizi güçtür, çünkü, bu düzeltici ameliyatlarının çoğunun erken sonuçları iyi olmakla birlikte geç dönem sonuçlan başarısız olabilir. 1989-2001 yılları arasında tedavi edilmiş, Dumping sendromu ve Dumping sendromu ile birlikte alkalen reflü gastrit sendromu olan toplam 21 hastanın klinik özellikleri ve düzeltici ameliyat sonuçlan, retrospektif olarak incelenmiştir. Ameliyat öncesi tüm hastalarda üst gastrointestinal grafiler, endoskopi ve sintigrafik muayene yapılmıştır. Hastaların uzun evre klinik takip bilgileri, hastane müşahadelerin gözden geçirilmesi, hastalarla doğrudan görüşme veya telefonla öğrenilmiştir. Klinik değerlendirme için Visick skalası kullanılmıştır. 21 hasta arasında 19'unda geç dönem sonuçları öğrenilmiştir. Roux-en-Y gastrojejunostomi 10 hastada başarılı bulunmuştur. Bir hastada Roux staz sendromu gelişmiştir. Bu hastada Neartotal gastrektomi uygulanmıştır. Medikal tedaviye cevap alınamayan ağır dumping ve dumping/alkalen reflü gastrit sendromlu hastalar için edindiğimiz tecrübeler ve literatür ışığında aşağıdaki stratejiyi öneriyoruz: a)Piloroplastili hastalar için kendi deneyimimiz olmamasına rağmen pilor rekonstrüksiyonu, b)Primer ameliyatında gastrojejunostomili hastalarda gastrojejunostomili iptali en basit ve fizyolojik yöntem olarak görünmektedir. c)Primer ameliyatında Billroth-I veya Billroth-II uygulanmış hastalarda Roux-en-Y konversiyonu Roux staz sendromu gibi komplikasyonlarına rağmen en etkili düzeltici ameliyattır.

Remedial operations for Dumping syndrome and Dumping syndrome associated alkaline reflox gastritis

Background and Design.- Many different remedial operation for dumping syndrome and associated alkaline reflux gastritis have been considered. No controlled trials have compared the relative efficiency of these operations. Analysis of their efficiency is difficult, because while many of the procedures have good early results, there are long term failures due to complications. Materials and Methods.- Clinical features and results of remedial operations of 21 patients with dumping syndrome and associated alkaline reflux gastritis syndrome treated between 1989 to 2001 were reviewed retrospectively. Preoperatively all patients who had symptoms were evaluated by upper gastrointestinal series, endoscopy and radionuclide scanning. Long term clinical follow-up data for all patients was collected by reviewing medical records, interviewing patients directly or through telephone call or both. Visick scale was used for clinical assessment. Results.- Among 21 patients,19 could be followed. Roux-en-Y gastrojejunostomy was succcesful in 10 patients, who had Visick-I and Visick-II scale. Roux stasis syndrome was developed in 1 patient. Near-total gastrectomy was performed in 1 patient due to stasis syndrome. Conclusions.- For patients with medically unresponsive, severe dumping and dumping/alkaline reflux gastritis symptoms, we recommend the following strategy: a) For patients with pyloroplasty, pyloric reconstruction should be the initial remedial operation, b) For patients with truncal vagotomy plus gastrojejunostomy, gastrojejunostomy should be taken down in initial remedial approach. c) For patients with prior Billroth-I or Billroth-II gastrectomy, Roux-en-Y conversion is the most effective corrective operation, although it has its own problems including Roux stasis syndrome.

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