Berat APAYDIN, Fadıl AYAN, Yılmaz ERSAN, Adem KARATAŞ, Kağan ZENGİN, Sinan ÇARKMAN, Murat ÖZCAN

Primer ameliyat sonrası nüks peptik ülserli hastalarda cerrahi tedavi sonuçları.

Medikal tedavinin etkinliği sayesinde peptik ülser sebebiyle ameliyat edilen hastaların sayısı azalsa da ameliyat olmuş hastalarda gelişen nüks ülserin cerrahi tedavisi halen önemli bir cerrahi problemdir.Peptik ülser nedeniyle ameliyat edilen hastaların uzun dönem sonuçlarının tatmin edici olmamasının başlıca nedenleri alkalen reflü gastrit ve nüks peptik ülserdir. Nüks ülser gelişiminden ilk cerrahi girişimin yetersiz veya uygunsuz olması sorumlu tutulur. Bu çalışmada 1989 – 2003 yılları arasında İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi Genel Cerrahi Anabilim dalında peptik ülser için çeşitli cerrahi girişimler sonrası nüks peptik ülser gelişen ve bu nedenle tekrar ameliyat edilen 46 hastanın verileri retrospektif olarak incelendi. Yeni bir cerrahi girişim için aday olan hastalar, yoğun medikal tedaviyle iyileşmeyenler, medikal tedaviye bağlı ciddi yan etki gösterenler, konservatif tedavi sırasında ülserleri nüksedenler ve komplikasyonlu nüks ülserlerdi. Nüks ülser için uygulanacak cerrahi yöntem primer ameliyatın niteliğine göre belirlendi. Eksik vagotominin tamamlanması, yetersiz rezeksiyonun genişletilmesi gibi tamamlayıcı işlemler kullanıldı. Serimizde cerrahi mortalite görülmedi. Mide ve duodenumun peptik ülser hastalığı için ameliyat geçirmiş olanlarda, mide, duodenum ve jejunumda yeniden oluşan ülserlere “Nüks Peptik Ülserler” denir. Anastomotik, stomal, marjinal ülserler sinonim terimlerdir. Tüm nüks ülserlerin % 95’i duodenal ülser için yapılan cerrahi girişimden sonra, sadece % 2-5’i , mide ülseri için yapılan cerrahi girişimden sonra oluşur. Peptik ülser hastalığı için cerrahi tedavi uygulanan hasta sayısı azalmaya devam ediyorsa da postoperatif nüks peptik ülser, alkalen reflü gastrit ile birlikte, yetersiz ve tatmin edici olmayan uzun dönem sonuçlarının en sık sebebidir [1, 2, 3].

Results of surgical treatment in patients with recurrent peptic ulcer after original operation

As a result of the efficacity of the medical therapy of peptic ulcer the quantity of the patients those receive surgical treatment are getting lower but it is still a problem as a recurring disease for the patient who had surgery because of peptic ulcer. Alkaline reflux gastritis and recurrent peptic ulcer are the main reasons of the long term unsatisfactory results. The insufficient or improper first surgical operation is usually responsible for the recurrent peptic ulcer. In this study, we evaluated, the retrospective data of 46 patients who underwent repeat surgery because of recurrent peptic ulcer after various surgical treatments between 1989-2003 in Department of General Surgery at Cerrahpasa Medical Faculty. The patients whose symptoms did not regress with medical therapy or developed side effects due to medical therapy, developed recurrent peptic ulcer during conservative treatment or the ulcers with complication were the candidate of the repeat surgical therapy. The surgical technique was determined according to primary surgery. Some complementary operations were performed such as the accomplishment of insufficient vagotomy and the enlargement of few resections. There were no surgical mortality in our series.

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