Laparoskopik Cerrahi Özel Sayısı
Laparoskopik Reflü Cerrahisi
LAPAROSCOPIC ANTIREFLUX SURGERY
Turkiye Klinikleri J Surg Med Sci. 2006;2(1):29-35
Article Language: TR
ÖZET
Gastroezofageal reflü (GER) ,batıda %20 sıklığında görülen en yaygın gastrointestinal sistem hastalığıdır. GER'de bulgular hafif semptomlardan Barret özofagus gelişimine kadar uzanan bir yelpazede bulunabilir. Günümüzde medikal tedavi asit inhibisyonu ile etkinliğini göstersede anatomik ve fizyolojik bozukluğu düzeltmede rolü yoktur. Reflü cerrahisi ise gastroözofageal bileşkenin ve diafragmatik kruranın anatomik düzeltmesini sağlayarak gerçek bir reflü bariyeri oluşturur. Laparoskopik reflü cerrahisi %95'in üzerinde başarı oranı ile orta ve uzun dönemde yaşam kalitesini düzeltmesiyle medikal tedavinin alternatifidir. Kişisel serimizde şimdiye kadar 842 kronik reflü hastasına laparoskopik reflü cerrahisi gerçekleştirdik. Operayonlarda vagus sinirlerini koruyarak gastroözofageal bileşke serbestlendi, kısa gastrik damarlar rutin olarak kesildi, kruslar kapatılarak 360 derecelik fundoplikasyon gerçekleştirildi.Ortalama takip süresi 42.19 ± 12.5 ay, ortalama ameliyat süresi 66.56 ± 13.38 dakika idi. Hastaların %96'sı operayonu başarılı bulmuşlardır. Laparoskopik reflü cerrahisi 5 yıl üzerinde uzun dönem kalıcılığı gösterilmiş, bazı hastalarda semptomlarda tam düzelme olmasa da %90 üzerinde başarısı olan seçkin bir yöntemdir.
Anahtar Kelimeler: Gastroözofageal reflü, laparoskopi, reflü cerrahisi
Gastroezofageal reflü (GER) ,batıda %20 sıklığında görülen en yaygın gastrointestinal sistem hastalığıdır. GER'de bulgular hafif semptomlardan Barret özofagus gelişimine kadar uzanan bir yelpazede bulunabilir. Günümüzde medikal tedavi asit inhibisyonu ile etkinliğini göstersede anatomik ve fizyolojik bozukluğu düzeltmede rolü yoktur. Reflü cerrahisi ise gastroözofageal bileşkenin ve diafragmatik kruranın anatomik düzeltmesini sağlayarak gerçek bir reflü bariyeri oluşturur. Laparoskopik reflü cerrahisi %95'in üzerinde başarı oranı ile orta ve uzun dönemde yaşam kalitesini düzeltmesiyle medikal tedavinin alternatifidir. Kişisel serimizde şimdiye kadar 842 kronik reflü hastasına laparoskopik reflü cerrahisi gerçekleştirdik. Operayonlarda vagus sinirlerini koruyarak gastroözofageal bileşke serbestlendi, kısa gastrik damarlar rutin olarak kesildi, kruslar kapatılarak 360 derecelik fundoplikasyon gerçekleştirildi.Ortalama takip süresi 42.19 ± 12.5 ay, ortalama ameliyat süresi 66.56 ± 13.38 dakika idi. Hastaların %96'sı operayonu başarılı bulmuşlardır. Laparoskopik reflü cerrahisi 5 yıl üzerinde uzun dönem kalıcılığı gösterilmiş, bazı hastalarda semptomlarda tam düzelme olmasa da %90 üzerinde başarısı olan seçkin bir yöntemdir.
Anahtar Kelimeler: Gastroözofageal reflü, laparoskopi, reflü cerrahisi
ABSTRACT
Gastroesophageal reflux disease (GERD) is the most common upper gastrointestinal disorder in the europe. Approximately 20% of adults in the Western population report heartburn at least once a week. Manifestations of this disease range from mild and infrequent symtoms to more serious complications such as Barrett's esophagus. Medical therapy for GERD focuses on suppressing gastric asid secretion, but does little to correct the anatomical and physiological abnormalities that predispose to gastroesophageal reflux. In contrast antireflux surgery attemts to correct the reflux diathesis by returning the gastroesophageal junction to its normal anatomical location within the abdomen, and by creating a barrier to reflux through fundoplication and through repair of the diaphragnatic crurae that surround the distal esophagus. Laparoscopic antireflux surgery (LARS) has become an effective alternative to lifelong antireflux medication therapy and the Standard approach to hiatal hernia repair and surgical therapy of GERD. Numerous studies have shown that LARS is a safe and effective treatment option with excellent midterm and longterm functional outcomes, that it results in high patient satisfaction (95%), and that it significantly improves patient's long term quality of life. A total number of 842 patients whom underwent laparoscopic floppy nissen fundoplication for GERD between March 1999 and june 2005 were included into the study. Five trocars were placed in the upper abdomen. The gastroespophageal junction was widely mobilized, and both vagus nerves were preserved. The short gastric vessels were routinely divided. Both crura were approximated posteriorly.After hiatal closure, the floppy nissen fundoplication was performed. The mean fallow-up was 42.19 ± 12.5 months. The mean operative time was 66.56±13.38 minutes. Ninety-six percent of the patients were satisfied with the results of the procedure (79% very satisfied, 15.3% satisfied, and 2,2% moderately satisfied) and 3.5% found it was no acceptaple (poor). LARS is an excellent long-term treatment for GERD with persistent succes for more than 5 years. Some patients have continuing symptomps and remain on therapy,but more than 90% of all patients undergoing LARS remain satisfied with their decision to have surgery.
Keywords: Gastroesophageal reflux, antireflux surgery, laparoscopy
Gastroesophageal reflux disease (GERD) is the most common upper gastrointestinal disorder in the europe. Approximately 20% of adults in the Western population report heartburn at least once a week. Manifestations of this disease range from mild and infrequent symtoms to more serious complications such as Barrett's esophagus. Medical therapy for GERD focuses on suppressing gastric asid secretion, but does little to correct the anatomical and physiological abnormalities that predispose to gastroesophageal reflux. In contrast antireflux surgery attemts to correct the reflux diathesis by returning the gastroesophageal junction to its normal anatomical location within the abdomen, and by creating a barrier to reflux through fundoplication and through repair of the diaphragnatic crurae that surround the distal esophagus. Laparoscopic antireflux surgery (LARS) has become an effective alternative to lifelong antireflux medication therapy and the Standard approach to hiatal hernia repair and surgical therapy of GERD. Numerous studies have shown that LARS is a safe and effective treatment option with excellent midterm and longterm functional outcomes, that it results in high patient satisfaction (95%), and that it significantly improves patient's long term quality of life. A total number of 842 patients whom underwent laparoscopic floppy nissen fundoplication for GERD between March 1999 and june 2005 were included into the study. Five trocars were placed in the upper abdomen. The gastroespophageal junction was widely mobilized, and both vagus nerves were preserved. The short gastric vessels were routinely divided. Both crura were approximated posteriorly.After hiatal closure, the floppy nissen fundoplication was performed. The mean fallow-up was 42.19 ± 12.5 months. The mean operative time was 66.56±13.38 minutes. Ninety-six percent of the patients were satisfied with the results of the procedure (79% very satisfied, 15.3% satisfied, and 2,2% moderately satisfied) and 3.5% found it was no acceptaple (poor). LARS is an excellent long-term treatment for GERD with persistent succes for more than 5 years. Some patients have continuing symptomps and remain on therapy,but more than 90% of all patients undergoing LARS remain satisfied with their decision to have surgery.
Keywords: Gastroesophageal reflux, antireflux surgery, laparoscopy
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