KORAY KARABULUT, CÜNEYT KIRKIL, Erhan AYGEN, Kenan BİNNETOĞLU, Refik AYTEN, Ziya ÇETİNKAYA, YAVUZ SELİM İLHAN, Mehmet YANLIZ

Laparoskopik nissen fundoplikasyonu: tek merkez deneyimi

Amaç: Gastroözofageal reflü hastalığının tedavisi için son üç yılda uyguladığımız Laparoskopik Nissen Fundoplikasyonu ameliyatlarının sonuçlarını değerlendirmek. Gereç ve Yöntemler: Kliniğimizde Haziran 2008 ile Mart 2011 tarihleri arasında Laparoskopik Nissen Fundoplikasyonu uygulanan 27 hasta, geriye dönük olarak incelendi. Hastalardan 15’i kadın (%56), 12’si erkekti (%44). Ortalama yaş 40’tı (20–67). Hastaların tamamına ameliyat öncesinde en az 2 ay süre ile medikal tedavi verildi. Tüm hastalara ameliyat öncesi endoskopi ve özofagus biyopsisi yapıldı. Ameliyatlar genel anestezi altında 5 port kullanılarak yapıldı. Ameliyattan sonraki gün tüm hastalara özofagus pasaj grafisi çekildi. Bulgular: Hastaların tamamında göğüste yanma ve mide içeriğinin ağza geri gelmesi şikâyetleri mevcuttu. Şikâyetlerin başlamasından ameliyata kadar geçen süre ortalama 12 aydı (4 ay–13 yıl). Ameliyat öncesi endoskopik incelemede bütün hastalarda özofajit tespit edildi. Histopatolojik incelemede, iki hastada Barrett özofajiti saptandı. Ameliyatların hiç birinde açığa geçilmedi. Ortalama ameliyat süresi 115 dakika (75-170 dk), ortanca hastanede kalış süresi 3 gün (1-7 gün) idi. Ortanca takip süresi 13 ay olarak belirlendi (7-40 ay). Bir hasta ilk ameliyatından 10 ay sonra nüks hiyatus fıtığı nedeniyle tekrar ameliyat edildi. Fonksiyonel sonuçlar hastaların %76’sında mükemmel, %14’ünde iyi, %10’unda orta olarak değerlendirildi. Sonuç: Laparoskopik Nissen Fundoplikasyonu, gastroözofageal reflü hastalığının tedavisinde, düşük morbidite ve mortalite oranı ile uygulanabilecek ve uzun süreli ilaç tedavisine alternatif, cerrahi bir girişimdir.

Laparoscopic nissen fundoplication: single-center experience

Objective: Our aim was examine the results of Laparoscopic Nissen Fundoplication operations performed for the treatment of gastroesophageal reflux disease within the last three years in our institution. Material and Methods: Twenty-seven patients who underwent Laparoscopic Nissen Fundoplication between June 2008 and March 2011 were retrospectively evaluated. There were 15 (%56) female and 12 (%44) male patients with a median age of 40 (range, 20-67 years). Prior to surgery all patients were given medical treatment for a period of at least two months. Endoscopy and esophageal biopsy was performed in all patients before surgery. Surgery was performed under general anesthesia using five ports. Esophagograms were obtained on postoperative first day for all patients. Results: All patients had complaints of heartburn and regurgitation. The median duration of symptoms before surgery was 12 months (range, 4 months-2 years). On preoperative endoscopic examination all of the patients had esophagitis and two of them had Barrett’s esophagitis on histopathologic examination. All of the procedures were performed by laparoscopy and there was no conversion to open. Median operative time was 115 minutes (range, 75-170 minutes), and length of hospital stay was 3 days (range, 1-7 days). Median follow-up period was 13 months (7-40 months). One of the patients underwent reoperation for recurrent disease 10 months after the first operation. Functional results was excellent in 76%, good in 14%, and fair in 10% of the patients on follow-up. Conclusion: Laparoscopic Nissen Fundoplication is a safe and effective surgical procedure for the treatment of gastroesophageal reflux disease and it is an alternative treatment option to long-term drug therapy.

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