Mehmet Emin GÖNÜLLÜ, İsmet ÖZAYDIN, Nurgül ALTINSOY, Hasan Can DEMİRKAYA

Migrasyon Olan Nissen Fundoplikasyon Meshinin Endoskopik Çıkarılması

Laparoskopik Nissen fundoplikasyonunun hiatal hernilerin tedavisi için güvenli ve uygulanabilir bir yöntem olduğu bilinmektedir. Bununla birlikte, %42 gibi bir nüks oranı da bildirilmiştir. Nissen fundoplikasyonu yapılan hastalarda meş onarımının kullanılması, bildirilen birkaç komplikasyon olmuş olsa bile, primer sütüre göre daha az nüks göstermiştir. Meş konulmasıyla oluşabilecek bazı komplikasyonlar şunlardır; şiddetli fibrozis, özofagus darlıkları, özofagus perforasyonları, barsak duvarında meş erozyonu ve üst gastrointestinal sisteme meş migrasyonu, vb. Bu raporda, yaklaşık 11 yıl sonra gelişen meşin özofagusa migrasyonu sunulmuştur. Bu gibi durumlarda, hastalarda birkaç cerrahi seçenek bulunabilir. Bu seçeneklerin arasından, endoskopik olarak meş tamamen yerinden çıkarıldı. İleri cerrahiye ihtiyaç duyulmadı. Sonuç olarak, hiatal hernilerin laparoskopik onarımı için cerrahın deneyimi, hiatus anatomisi ve hastanın semptomları da dikkate alınarak çok seçici bir meş kullanılması önerilir.

Anahtar Kelimeler:

Nissen Fundoplikasyonu, Mesh Migrasyonu, Endoskopik Çıkarma

Endoscopic Removal of Migrated Nissen Fundoplication Mesh

Laparoscopic Nissen fundoplication is known to be a safe and feasible method in the treatment of hiatal hernias. However, a recurrence rate of 42% has been reported. Using mesh repair in patients undergoing Nissen fundoplication has shown fewer recurrence rates than the primary suture, even though there have been few complications reported. Some complications that may occur with mesh placement are; severe fibrosis, esophageal strictures, esophageal perforations, mesh migration to the upper gastrointestinal tract, and mesh erosion in the intestinal wall, etc. In this report, the migration of the leathery esophagus developed after about 11 years was presented. In such cases, patients may have several surgical options. Among these options, the mesh was completely removed endoscopically. No further surgery was required. In conclusion, it is recommended to use a very selective mesh in the laparoscopic repair of the hiatal hernias, considering the surgeon's experience, hiatus anatomy, and patient's symptoms.

Keywords:

Nissen Fundoplication, Mesh Migration, Endoscopic Removal,

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