Abstract
Giriş: Gastroözofageal reflü hastalığı (GÖRH), çocukluk yaş grubunda sık görülen hastalıklardan biridir. Özellikle nörolojik sorunları olan olgularda uygulanan fundoplikasyon işleminin akibeti hala tartışmalıdır. Son iki dekatta laparoskopik fundoplikasyon uygulamasının rutine girmesi ile cerrahi girişimlerde önemli ilerlemeler sağlanmıştır. Bu çalışmada biz açık ve laparoskopik Nissen fundoplikasyonu yaptığımız nörolojik problemi olan ve olmayanlarda postoperatif dönemdeki komplikasyonları karşılaştırmayı hedefledik.
Materyal-Metod: Bu çalışmada kliniğimizde 2009-2014 yılları arasında gerçekleştirilen açık ve laparoskopik Nissen operasyonları ve sonrasında gelişen komplikasyonları retrospektif olarak incelenmiştir.
Bulgular: Değerlendirmeye 5 gün - 18 yaş arası 29 kız ve 35 erkek hasta dahil edildi. Olguların 38'inde nörolojik problem mevcuttu. 14 olguya laparoskopik cerrahi, 50 olguya açık cerrahi tercih edildi. Postoperatif dönemde 31 hastada komplikasyon görülmezken 11 hastada yara enfeksiyonu, 9 hastada akciğer enfeksiyonu, 9 hastada kusma, 1 hastada hemopnömotoraks, 1 hastada mide perforasyonu gelişti. Postoperatif komplikasyona göre nörolojik problemleri olan ve olmayan hastalarımız arasında istatistiksel olarak anlamlı fark yoktu. Hiçbir hastada reflü nüksü veya hiatal herni gelişmedi. Çalışmamızda hastalarımız ortalama 20,43 +/- 13,34 gün arasında 4 gün ile 87 gün arasında hastanede kalmıştır. Laparoskopik ve açık Nissen operasyonu olan olgularda, hastane yatış süresi açısından bir fark yoktu.
Sonuç: Sonuç olarak, laparoskopik ve açık fundoplikasyon olguları arasında hastaneye yatış ve komplikasyon oranları arasında fark yoktu. Ameliyat öncesi dönemde pnomoni varlığı, yapılacak cerrahi müdahalenin morbiditesini arttırmaktadır. Preoperatif akciğer problemlerini en aza indirdikten sonra operasyon planlanması bu hastalarda morbiditeyi azaltan en önemli faktördür.
Supporting Institution
yok
Project Number
yok
References
- 1. Mauritz, F.A., et al., The effects and efficacy of antireflux surgery in children with gastroesophageal reflux disease: a systematic review. J Gastrointest Surg, 2011. 15(10): p. 1872-8.
- 2. Slater, B.J. and S.S. Rothenberg, Gastroesophageal reflux. Semin Pediatr Surg, 2017. 26(2): p. 56-60.
- 3. Esposito, C., et al., Long-term outcome of laparoscopic Nissen, Toupet, and Thal antireflux procedures for neurologically normal children with gastroesophageal reflux disease. Surg Endosc, 2006. 20(6): p. 855-8.
- 4. Smith, C.D., et al., Nissen fundoplication in children with profound neurologic disability. High risks and unmet goals. Ann Surg, 1992. 215(6): p. 654-8; discussion 658-9.
- 5. Wheatley, M.J., A.G. Coran, and J.R. Wesley, Efficacy of the Nissen fundoplication in the management of gastroesophageal reflux following esophageal atresia repair. J Pediatr Surg, 1993. 28(1): p. 53-5.
- 6. Franzen, T., et al., Long-term outcome is worse after laparoscopic than after conventional Nissen fundoplication. Scand J Gastroenterol, 2005. 40(11): p. 1261-8.
- 7. Barsness, K.A., et al., Laparoscopic versus open Nissen fundoplication in infants after neonatal laparotomy. JSLS, 2007. 11(4): p. 461-5.
- 8. Rothenberg, S.S., Experience with 220 consecutive laparoscopic Nissen fundoplications in infants and children. J Pediatr Surg, 1998. 33(2): p. 274-8.
- 9. Siddiqui, M.R., et al., A meta-analysis of outcomes after open and laparoscopic Nissen's fundoplication for gastro-oesophageal reflux disease in children. Pediatr Surg Int, 2011. 27(4): p. 359-66.
- 10. Georgeson, K.E., Laparoscopic gastrostomy and fundoplication. Pediatr Ann, 1993. 22(11): p. 675-7.
- 11. Lobe, T.E., K.P. Schropp, and K. Lunsford, Laparoscopic Nissen fundoplication in childhood. J Pediatr Surg, 1993. 28(3): p. 358-60; discussion 360-1.
- 12. Garvey, E.M. and D.J. Ostlie, Hiatal and paraesophageal hernia repair in pediatric patients. Semin Pediatr Surg, 2017. 26(2): p. 61-66.
- 13. Jancelewicz, T., et al., Surgical management of gastroesophageal reflux disease (GERD) in children: A systematic review. J Pediatr Surg, 2017. 52(8): p. 1228-1238.
- 14. Salminen, P.T., et al., Comparison of long-term outcome of laparoscopic and conventional nissen fundoplication: a prospective randomized study with an 11-year follow-up. Ann Surg, 2007. 246(2): p. 201-6.
- 15. Kubiak, R., J. Andrews, and H.W. Grant, Laparoscopic Nissen fundoplication versus Thal fundoplication in children: comparison of short-term outcomes. J Laparoendosc Adv Surg Tech A, 2010. 20(7): p. 665-9.
Abstract
Introduction: Gastroesophageal reflux (GERD) disease is one of the most common diseases in pediatric population. The fate of the fundoplication procedure, especially in patients with neurological problems, is still controversial. With the introduction of laparoscopic fundoplication application in the last two decades, significant advances have been made in surgical interventions. In this study, we aimed to compare the postoperative complications in patients with and without neurological problems with whom we performed open and laparoscopic Nissen fundoplication.
Material-Metod: The aim of this study is to present laparoscopic and open Nissen fundoplication cases performed for GERD in our clinic between 2009-2014 and compare the complications.
Results: 29 female and 35 male patients aged between 5 days -18 years (mean 7.06 +/- 5.16) were included in the evaluation. There were neurological problems in 38 of them were accompanied by neurological problems. laparoscopic surgery was performed to 14 cases and open surgery was preferred for 50 cases. In the postoperative period, while there were no complications in 31 patients, 11 cases had wound infection, 9 cases had pulmoner infection, 9 cases were vomiting, 1 case had hemopneumothorax, 1 case had a gastric perforation.
Conclusion: The prevalence of pulmonary problems in the preoperative period, increases the morbidity of the surgical intervention to be made. The most important factor affecting morbidity in such patients, after minimizing preoperative pulmonary problems.
Project Number
yok
References
- 1. Mauritz, F.A., et al., The effects and efficacy of antireflux surgery in children with gastroesophageal reflux disease: a systematic review. J Gastrointest Surg, 2011. 15(10): p. 1872-8.
- 2. Slater, B.J. and S.S. Rothenberg, Gastroesophageal reflux. Semin Pediatr Surg, 2017. 26(2): p. 56-60.
- 3. Esposito, C., et al., Long-term outcome of laparoscopic Nissen, Toupet, and Thal antireflux procedures for neurologically normal children with gastroesophageal reflux disease. Surg Endosc, 2006. 20(6): p. 855-8.
- 4. Smith, C.D., et al., Nissen fundoplication in children with profound neurologic disability. High risks and unmet goals. Ann Surg, 1992. 215(6): p. 654-8; discussion 658-9.
- 5. Wheatley, M.J., A.G. Coran, and J.R. Wesley, Efficacy of the Nissen fundoplication in the management of gastroesophageal reflux following esophageal atresia repair. J Pediatr Surg, 1993. 28(1): p. 53-5.
- 6. Franzen, T., et al., Long-term outcome is worse after laparoscopic than after conventional Nissen fundoplication. Scand J Gastroenterol, 2005. 40(11): p. 1261-8.
- 7. Barsness, K.A., et al., Laparoscopic versus open Nissen fundoplication in infants after neonatal laparotomy. JSLS, 2007. 11(4): p. 461-5.
- 8. Rothenberg, S.S., Experience with 220 consecutive laparoscopic Nissen fundoplications in infants and children. J Pediatr Surg, 1998. 33(2): p. 274-8.
- 9. Siddiqui, M.R., et al., A meta-analysis of outcomes after open and laparoscopic Nissen's fundoplication for gastro-oesophageal reflux disease in children. Pediatr Surg Int, 2011. 27(4): p. 359-66.
- 10. Georgeson, K.E., Laparoscopic gastrostomy and fundoplication. Pediatr Ann, 1993. 22(11): p. 675-7.
- 11. Lobe, T.E., K.P. Schropp, and K. Lunsford, Laparoscopic Nissen fundoplication in childhood. J Pediatr Surg, 1993. 28(3): p. 358-60; discussion 360-1.
- 12. Garvey, E.M. and D.J. Ostlie, Hiatal and paraesophageal hernia repair in pediatric patients. Semin Pediatr Surg, 2017. 26(2): p. 61-66.
- 13. Jancelewicz, T., et al., Surgical management of gastroesophageal reflux disease (GERD) in children: A systematic review. J Pediatr Surg, 2017. 52(8): p. 1228-1238.
- 14. Salminen, P.T., et al., Comparison of long-term outcome of laparoscopic and conventional nissen fundoplication: a prospective randomized study with an 11-year follow-up. Ann Surg, 2007. 246(2): p. 201-6.
- 15. Kubiak, R., J. Andrews, and H.W. Grant, Laparoscopic Nissen fundoplication versus Thal fundoplication in children: comparison of short-term outcomes. J Laparoendosc Adv Surg Tech A, 2010. 20(7): p. 665-9.
Details
| Primary Language | English |
|---|---|
| Subjects | Surgery |
| Journal Section | ORIGINAL ARTICLES |
| Authors | |
| Project Number | yok |
| Publication Date | September 29, 2020 |
| Submission Date | May 20, 2020 |
| Published in Issue | Year 2020 Volume: 14 Issue: 5 |
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