TURGUT ANUK, Şahin KAHRAMANCA, Ali Cihat YILDIRIM, Mahmut Can YAĞMURDUR

Gastro özefageal reflü hastalığı (GÖRH) cerrahisinde yaşam kalitesine etki eden preoperatif faktörler

Amaç: Mide içeriğinin, haftada ikiden fazla günde özofagusa kaçarak retrosternal yanmaya yol açması, gastroözofageal reflü hastalığı (GÖRH) olarak adlandırılır. Antiasit tedaviye direnç gösteren ve komplikasyon gelişen olgularda anti reflü cerrahi uygulanmaktadır. Çalışmamızda, GÖRH saptanıp, Laparoskopik Nissen Fundoplikasyonu (LNF) yapılan hastalarda, postoperatif 6. ayda hasta tarafından doldurulan yaşam kalite ölçeği (SF 36) skorlarına etki eden preoperatif faktörleri ortaya koymayı amaçladık. Gereç ve yöntem: Polikliniğe epigastrik bölgede ağrı, retrosternal yanma şikayetleriyle başvurarak GÖRH tanısı alan ve LNF uygulanan 69 hastanın dosyasından yaş, cinsiyet, Helicobacter pylori (HP), alkalen reflü gastrit (ARG) pozitifliği, vücut kitle indeksleri (VKİ), hiatus herni (HH) çapları kaydedildi. SF 36 formunu doldurmayan, dosya kayıtlarında ve takiplerinde eksiklik bulunan, konversiyon fundoplikasyon ve redo surgery uygulanan 27 hasta çalışma dışı bırakıldı. Bu özelliklerin, postoperatif altıncı ay SF 36 formlarındaki yaşam kalitesine etkileri incelendi. Bulgular: Çalışmamızda 22 hastada HP, 19 hastada ARG pozitifliği saptandı. Yirmi yedi hastada VKİ 35-39,9 kg/m2 olarak hesaplandı. Kadın cinsiyette ağrıya yanıtın daha yüksek olduğu (p=0,041) olduğu gözlenirken, HP pozitifliği olan grupta duygusal rol kısıtlılığında azalma (p=0,039) daha anlamlıydı. ARG pozitifliği saptanan hastalarda, SF 36 formunda anlamlı değişiklik gözlenmedi (p>0,05). HH çapı incelendiğinde, fiziksel fonksiyon ve ağrıya, daha geniş HH’si olan hastalarda daha yüksek oranda yanıt alındığı gözlendi (p= 0,039 ve p= 0,037). VKİ 30-34,9 kg/m2 arası olan grupta ağrıya yanıtın daha iyi olduğu gözlendi (p<0,001). Sonuç: Düşük VKİ’ye sahip, geniş hiatal hernisi olan ve LNF uygulanan GÖRH’li hastalarda uygulanan cerrahinin değerlendirilmesinde SF 36 yaşam kalite indeksinin kullanılabileceği ve uygulanan LNF’nin başarılı sonuç verdiği sonucuna ulaştık.

Anahtar Kelimeler:

Gastroözefageal reflü hastalığı, Laparoskopik Nissen fundoplikasyonu, SF 36 skoru

Preoperative Factors Affecting Health Quality Of Patients Undergone Surgery For Gastroesophageal Reflux Disease

Objective: GORD(Gastroesophageal reflux disease)is described as reflux of gastric content to esophagus leading to retrosternal burn more than twice in a week.Cases resistant to anti-acid therapy and who were complicated are candidates for anti-reflux surgery.In this study our aim is to show and analyze preoperative factors affecting SF36 health survey scores of patients undergone Laparoscopic Nissen Fundoplication(LNF) surgery for GORD at postoperative sixth month.Material and method: Patients who had complaints of pain located on epigastric region,retrosternal burn and were diagnosed as GORD,were undergone LNF;whose data of Helicobacter pylori(HP) positivity,alkalen reflux gastritis(ARG) positivity,body mass indices(BMI),diameters of hiatal hernia(HH) were recorded.27 patients were excluded from the study who didn’t fill out the SF36 form, had some missing information in their registration or follow-up files,and undergone conversion fundoplication or retro surgery.The effects of these factors on SF36 Health Survey form were analyzed on postoperative sixth month and compared.Results: 22 patients had HP,19 patients had ARG positivity.27 patients had BMI’s between 35-39.9kg/m2.Female patients had more sensitivity to pain(p=0,041),however patients with HP positivity had more disability of emotional role statistically(p=0,039).There was not statistically significant in SF36 form of patients with ARG positivity(p>0.05).Patients with wider HH tent to have more response for physical functions and pain(p=0.039, p=0.037). Patients with BMI’s between 30-34.9 kg/m2 tent to have more response to pain(p<0.001).Conclusion: Our results show that LNF surgery could be successfully performed for GORD treatment and SF36 test could be useful in evaluation of surgical quality of GORD patients undergone LNF surgery especially who have low BMI’s and large hiatal hernia.

Keywords:

Gastroesophageal reflux disease, Laparoscopic Nissen Fundoplication, SF36 scores,

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