Akalazya hastalığının cerrahi tedavisinde laparoskopik Heller miyotomi ve Toupet fundoplikasyonu

Amaç: Çalışmamızın amacı akalazya tanısı ile laparoskopik Heller miyotomi ve Toupet fundoplikasyon işlemi uygulanan hastaların sonuçları değerlendirmektir. Gereç ve Yöntem: Mart 2004 ile Mart 2012 arası laparoskopik Heller miyotomi ve Toupet fundoplikasyon işlemi uygulanan ardışık 11 hastanın sonuçları prospektif veri tabanında analiz edildi. Bulgular: Toplamda 11 olgu opere edilmiş olup, tüm ameliyatlar laparoskopik olarak sonlandırılmıştır. Mortalite veya erken dönem komplikasyon görülmemiştir. Hastaların 7'si erkek, 4'ü kadın olup yaş ortalaması 32 (27-45) idi. Beş hastada önceden uygulanmış balon dilatasyon tedavisi öyküsü mevcut olup 6 hastada cerrahi girişim ilk tercih olarak uygulanmıştır. Ortalama ameliyat süresi 93 (54-150) dakika olup ortalama taburcu süresi 2 (1-3) gündü. Hastaların hiçbirinde postoperatif takiplerinde gastroözofageal reflü semptomları olmamıştır. Ortalama 48 aylık takip süresinde, 10 (%90.9) hastada yutma güçlüğü tamamen geçmiş olup, 1 (%9.1) hastada postoperatif ikinci yıl başlayıp halen süren tolere edilebilir yutma güçlüğü görülmüştür. Sonuç: Akalazya tedavisinde laparoskopik Heller miyotomi ve Toupet fundoplikasyon ameliyatı, kalıcı düzelme sağlayan etkin ve güvenilir bir yöntemdir.

Laparoscopic Heller myotomy and Toupet fundoplication in the surgical treatment of achalasia

Objective: The aim of this study is to evaluate the clinical results of patients undergoing laparoscopic Heller myotomy and the Toupet fundoplication procedure with the diagnosis of achalasia. Materials and Methods: Between March 2004 and March 2012, 11 patients who underwent laparoscopic Heller myotomy and Toupet fundoplication were retrospectively analyzed in a prospectively collected data base. Results: Eleven cases were operated during the study period and all were conducted laparoscopically. There were no early period complications or mortality. Seven patients were male and 4 were female. The mean age was 32 (27-45) years. While five patients had a history of balloon dilation therapy, surgical procedure was the first choice in 6 of them. The mean operative time was 93 (54-150) minutes and the average discharge time was 2 (1-3) days. None of the patients complained of postoperative gastroesophageal reflux symptoms. The average follow-up period of 48 months, 10 (90.9%) patients were free from dyphagia. One (9.1%) patient still had tolerable dysphagia which started in the second postoperative year. Conclusion: In the surgical treatment of achalasia, laparoscopic Heller myotomy and Toupet fundoplication is an effective and safe method for providing a permanent improvement.

Kaynakça

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