Erol BASUGUY, M.Hanifi OKUR, Serkan ARSLAN, Bahattin AYDOĞDU, Sevinç AKDENİZ, MUSTAFA AZİZOĞLU

Çocuklarda torakoport yardımlı laparoskopik apendektomi sonuçlarımız

Amaç: Açık, klasik multiport laparoskopi ve single insizyon laparoskopik cerrahinin (SILS) dezavantajlarının daha az olduğu torakoport yardımlı laparoskopik apendektomi deneyimlerimizi sunmayı amaçladık Yöntemler: Çalışmada 2018 Ocak ve 2019 Aralık yılları arasında Dicle Üniversitesi Tıp Fakültesi Çocuk Cerrahi kliniğinde akut apandisit nedeniyle apendektomi yapılan hastaların verileri geriye doğru incelendi. Hastaların cinsiyeti, yaşı, başvuru şikayetleri, tanı yöntemleri, laboratuvar tetkikleri, yapılan işlem, uygulanan tedavi yöntemleri ve hastanede kalış süreleri değerlendirildi. USG’ de net olarak ayırt edilemeyen şüpheli bulgular izlenen ve ek patolojiler olabileceği düşünülen hastalara kontrastlı Bilgisayarlı Tomografi (BT) istendi. Operasyondan bir gün sonra hastanın kliniği uygunsa oral başlandı. Takiplerde herhangi bir problemi olmayan hasta önerilerle taburcu edildi. Bir hafta sonra hastalar patoloji sonuçları ile kontrole çağırıldılar. Oluşan komplikasyonlar kaydedildi. Bulgular: Çalışmamızda 177’si (%63,7) erkek, 101’i (%36,3) kız olmak üzere toplam 278 hasta vardı. Hastaların yaş ortalaması 11.6 (2-17) idi. Hastaların başlıca semptomları: Karın ağrısı %93.1 (n:260), iştahsızlık %79,1 (n:220), bulantı %26,9 (n:75), kusma %16,9 (n:47) ve ateş %4 (n:12) idi. Hastaların laboratuvar tetkiklerinde 209 (%75,2) hastanın WBC’ si yüksekti. CRP yüksekliği 218 (%78,4) hastada tespit edildi. USG’ de 235 (%84) hastada anlamlı bulgular izlendi. BT çekilen 16 hastanın ise 14’ünde (%5,03) apandisitle uyumlu bulgular izlendi. Hastaların tamamına ameliyata torakoport yardımlı laparaskopi ile başlandı. İşlem 250 (%89,2) hastada torakoport yardımlı laparoskopik apendektomi olarak tamamlandı. Beş hastada 2. port, 10 hastada 3. port ihtiyacı oldu. On üç hastada laparoskopik işlem sonlandırıldı ve açık cerrahiye geçildi. Hastaların ortalama yatış süresi 1.7 (1-4) gün idi. Komplikasyon olarak 4 hastada brid ileus, 3 hastada yara yeri enfeksiyonu, 1 hastada umblikal herni gelişti ve cerrahi olarak düzeltildi. Brid ileus gelişen hastaların 3’ü konservatif olarak, birisi cerrahi olarak düzeltildi. Sonuç: Torakoport yardımlı laparaskopik apendektomi minimal invaziv bir yöntem olup kozmetik, maliyet, cerrahi işlemin kolaylığı, ağrı, hastanede yatış süresinin azlığı ve düşük komplikasyon gibi avantajları ile kullanılmasını önermekteyiz

Our results of thoracoport-aided laparoscopic appendectomy in children

Objective: We aimed to present our experiences with thoracoport-assisted laparoscopic appendectomy, which has fewer disadvantages than open, conventional multiport laparoscopic and single-incision laparoscopic surgery (SILS). Methods: In study, the data of patients, who underwent appendectomy for acute appendicitis between January 2018 and December 2019 in the Pediatric Surgery Clinic of Dicle University Faculty of Medicine Hospital, were retrospectively analyzed. Patients' gender, age, admission complaints, diagnostic methods, laboratory tests, procedure, treatment methods and length of hospital stay were evaluated. Contrast-enhanced Computed Tomography (CT) was ordered for patients with unclear and suspicious findings on the US and who were considered to have additional pathologies. One day after the operation, the patient was initiated on oral nutrition, if the clinic was appropriate. The patient with no problems in the follow-up was discharged with recommendations. One week later, the patients were invited to follow-up with pathology results. The complications that occurred were recorded Results: Our study included a total of 278 patients, 177 (63.7%) males, and 101 (36.3%) females. The mean age of the patients was 11.6 years (range, 2-17 years). The main symptoms of the patients were abdominal pain 93.1% (n: 260), anorexia 79.1% (n: 220), nausea 26.9% (n: 75), vomiting 16.9% ( n: 47), a nd e levated fever 4% ( n: 12). In the laboratory tests of the patients, 209 (75.2%) patients had high elevated WBC. CRP elevation was noted in 218 (78.4%) patients. The US examination of 235 (84%) patients was significant. Of the 16 patients who underwent CT, 14 (5.03%) had findings consistent with appendicitis. The surgery was started with a thoracoport-assisted laparoscopy in all patients. In 250 (89.2%) patients, the procedure was completed as a thoracoport-assisted laparoscopic appendectomy. Five patients required a second port and 10 patients required a third port. In 13 patients, the laparoscopic procedure was terminated and converted to open surgery. The mean length of hospital stay of the patients was 1.7 days (range 1-4 days). In terms of complications, 4 patients developed brid ileus, 3 patients developed wound infection, and 1 patient developed an umbilical hernia, which was surgically corrected. Of the patients who developed brid ileus, 3 underwent conservative correction and one underwent surgical correction. Conclusion: Thoracoport-assisted laparoscopic appendectomy is a minimally invasive method, and we recommend to use with its advantages such as cosmetics, cost, easy surgical procedures, pain, shorter length of hospital stay and low complication rate.

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