Atila EROĞLU, Atila TÜRKYILMAZ, Yener AYDIN, Nurettin KARAOĞLANOĞLU, Hacı Ahmet ALICI

The use of pedicled omentum flap in the prevention of esophagogastric anastomotic leak in esophageal cancer

Amaç: Bu çalışmada Ivor Lewis (transtorasik) tipi özofajektomide anastomoz kaçağını önlemede pediküllü omental flep kullanımının etkinliği araştırıldı.Çalışma planı: Ocak 2000 ve Aralık 2007 tarihleri arasında Atatürk Üniversitesi Tıp Fakültesi Hastanesi Göğüs Cerrahisi Kliniği’nde özofagus kanseri nedeniyle Ivor Lewis tipi özofajektomi ve özofagogastrik anastomoz uygulanan 132 hastanın (48 erkek, 84 kadın; ort. yaş 56.7±12.5 yıl; dağılım 16-80 yıl) kayıtları geriye dönük olarak değerlendirildi. Rekonstrüksiyon organı olarak mide seçildi ve özofagogastrik anastomoz toraksta yapıldı. Özofagogastrik anastomoz ve gastrik sütür hattı pediküllü omental flep ile sarıldı.Bulgular: Komplikasyon 65 hastada (%49.2) gelişti. Anastomoz kaçağı beş hastada (%3.8) gelişti. Hastane mortalite oranı (30 günlük mortalite oranı) %5.3 (n=7) idi. Birincil ölüm nedenleri anastomoz kaçağı ve solunum yetmezliği idi. Ameliyat sonrası ortalama yatış süresi 13.8 gün idi. Hastaların üç ve beş yıllık sağkalım oranları sırasıyla %39.5 ve %19.6 idi.Sonuç: Klinik deneyimlerimize göre özofagus kanserinde özofajektomi sonrası özofagogastrik anastomozda pediküllü omental flep kullanımı anastomoz kaçak insidansını önemli derecede azaltmaktadır.

Özofagus kanserinde özofagogastrik anastomoz kaçağını önlemede pediküllü omental flep kullanımı

Background: In this study, we investigate the effectiveness of the pedicled omental flap in preventing leakage after Ivor Lewis (transthoracic) type esophagectomy.Methods: The records of 132 patients (48 males, 84 females; mean age 56.7±12.5 years; range 16 to 80 years), in whom Ivor Lewis-type esophagectomy and esophagogastric anastomosis were performed between January 2000 and December 2007 in the Department of Thoracic Surgery of the Atatürk University Medical Faculty Hospital, were evaluated retrospectively. Esophagogastric anastomosis was made in the thorax and stomach was chosen for reconstruction. The esophagogastric anastomosis and gastric suture line were wrapped with a pedicled omental flap.Results: Complications developed in 65 patients (49.2%). Anastomotic leak developed in five patients (3.8%). Hospital mortality rate (30-day mortality rate) was 5.3% (n=7). Primary causes of mortality were anastomotic leak and respiratory failure. Mean hospital stay after operation was 13.8 days. Three and five year survival rates of the patients were 39.5% and 19.6% respectively.Conclusion: According to our clinical experiences, the use of pedicled omentum in esophagogastric anastomosis significantly reduces the incidence of anastomotic leak after esophagogastrectomy for carcinoma of the esophagus.

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