Single Camera Port Laparoscopic Gastrostomy Surgery In Adult Patients Postoperative Morbidity Related Factors And Comparing The Results With Open Gastrostomy Technique
Öz
Patients who cannot be feed orally should
be feed via the gastrostomy catheter. This catheter could be placed as surgical
gastrostomy or a percutaneous endoscopic gastrostomy(PEG). Surgical gastrostomy
is required when PEG is not possible. In this article, we aimed to discuss the
postoperative morbidity-related factors of U suture single camera port
laparoscopic gastrostomy operation and compare the results with open
gastrostomy procedure.
Methods
All patients were operated in xxx
xxx University Department of General Surgery between August 2010 and May 2018. The
data of 30 laparoscopic gastrostomy and 30 open gastrostomy patients were
analyzed retrospectively.
Results
Median age for laparoscopic and open
procedure:62(27-83)&59(19-82). The most
indication in two group: obstructive head and neck malignancies. Mean operation
time:37,7(±15,1)&75,1(±24,1)min. The most post-operative complication:
Pneumonia:7(23%)&10(33%). Pneumonia-related
mortality:3(10%)&5(17%). The risk factors for
complications: Pre-operative NG catheter feeding(OR:13.189),
pre-operative medical history of pulmonary infection(OR:20.848) and open
gastrostomy (OR:9,72).
Conclusion
Parenteral nutrition for a long time
increases the risk of morbidity of the patients who cannot be feed per-orally.
Feeding via the PEG catheter is the best
method for these patients. Patients with unsuccessful PEG attempt need surgical
gastrostomy. We have to avoid the long-time NG catheter feeding. Surgical intervention
should perform before nosocomial pneumonia occurred for these patients. In
these patients, single-camera port laparoscopic gastrostomy technique can be
preferred with low morbidity rates, instead of an open approach.
Anahtar Kelimeler
PEG Percutaneous endoscopic gastrostomy Enteral feeding Gastrostomy Laparoscopic gastrostomy peg
Kaynakça
- (1) STAMM, M. Gastrostomy by a new method. Med News 1894; 65: 324–326.
- (2) Gauderer MW, Ponsky JL, Izant RJ. Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg 1980; 15: 872–5.
- (3) Beres A, Bratu I, Laberge JM. Attention to small details: big deal for gastrostomies. Semin Pediatr Surg. Epub ahead of print 2009. DOI: 10.1053/j.sempedsurg.2009.02.005.
- (4) Georgeson KE. Laparoscopic gastrostomy and fundoplication. Pediatr Ann 1993; 22: 675–7.
- (5) Alverdy J, Chi HS, Sheldon GF. The effect of parenteral nutrition on gastrointestinal immunity. The importance of enteral stimulation. Ann Surg 1985; 202: 681–4.
- (6) Deitch EA, Ma WJ, Ma L, et al. Protein malnutrition predisposes to inflammatory-induced gut-origin septic states. Ann Surg 1990; 211: 560-7; discussion 567-8.
- (7) Baeten C, Hoefnagels J. Feeding via nasogastric tube or percutaneous endoscopic gastrostomy. A comparison. Scand J Gastroenterol Suppl 1992; 194: 95–8.
- (8) Park RH, Allison MC, Lang J, et al. Randomised comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding in patients with persisting neurological dysphagia. BMJ 1992; 304: 1406–9.
- (9) Mekhail TM, Adelstein DJ, Rybicki LA, et al. Enteral nutrition during the treatment of head and neck carcinoma: is a percutaneous endoscopic gastrostomy tube preferable to a nasogastric tube? Cancer 2001; 91: 1785–90.
- (10) Evaristo-Méndez G, Rocha-Calderón CH. Factores de riesgo para neumonía nosocomial en pacientes con cirugía abdominal. Cir Cir 2016; 84: 21–27.
- (11) Wolkewitz M, Vonberg R, Grundmann H, et al. Risk factors for the development of nosocomial pneumonia and mortality on intensive care units: application of competing risks models. Crit Care 2008; 12: R44.
- (12) Van Dusen R, Radomski M, Vaziri K, et al. Comparison of complications following laparoscopic versus open gastrostomy. J Am Coll Surg 2013; 217: S14–S15.
- (13) Antoniou SA, Antoniou GA, Koch OO, et al. Laparoscopic versus open obesity surgery: a meta-analysis of pulmonary complications. Dig Surg 2015; 32: 98–107.
- (14) Antoniou SA, Antoniou GA, Koch OO, et al. Meta-analysis of laparoscopic vs open cholecystectomy in elderly patients. World J Gastroenterol 2014; 20: 17626–34.
- (15) Biondi A, Di Stefano C, Ferrara F, et al. Laparoscopic versus open appendectomy: a retrospective cohort study assessing outcomes and cost-effectiveness. World J Emerg Surg 2016; 11: 44.
Erişkin Hastada Tek Kamera Portu İle Laparoskopik Gastrostomi Postoperatif Morbidite İlişkili Faktörler ve Sonuçların Açık Gastrostomi Tekniği İle Karşılaştırılması
Öz
Oral yoldan beslenemeyen
hastalar için enteral beslenme mideye yerleştirilen kateter vasıtasıyla
yapılabilir. Bu bir Nazogastrik(NG) kateter, cerrahi gastrostomi kateteri ya da
peruktan endoskopik gastrostomi(PEG) kateteri olabilir. PEG uygulamasının
mümkün olmadığı durumlarda cerrahi gastrostomi uygulaması gerekir. Bu makalede
tek kamera portu kullanılarak U dikiş tekniği ile laparoskopik yöntemle
gastrostomi kateteri yerleştirilen hastalarda postoperatif morbidite ilişkili
faktörlerin tartışılması ve sonuçların açık gastrostomi sonuçlarıyla
karşılaştırılması amaçlanmıştır.
Materyal ve
Metot
Dokuz Eylül Üniversitesi
Genel Cerrahi Anabilim Dalı’nda tek kamera portu kullanılarak Mart 2014-Mayıs
2018 tarihleri arasında laparoskopik gastrostomi ameliyatı yapılmış 30 ile
Ağustos 2010-Temmuz2015 tarihleri arasında açık gastrostomi yapılmış 30
hastanın verileri geriye dönük dosya inceleme yöntemi ile elde edilerek
incelendi.
Bulgular
Laparoskopik
ve açık gastrostomi hastaları için grup için ortanca yaş:62(27-83) & 59(19-82). İki grup için de en
sık endikasyon: Baş-boyun malignitesi olan hastalarda kapalı ağız-mide pasajı.
Ortalama ameliyat süresi: 37,7(±15,1)&75,1(±24,1)dakika. En sık
postoperatif komplikasyon: Pnomoni:7(%23)&10(%33), 3(%10)&5(%17)
hastada pnomoni ilişkili mortalite. Komplikasyon ilişkili risk faktörleri: Pre
op NG sonda ile besleme (OR:13.189) pulmoner
enfeksiyon öyküsü(OR:20.848),
açık gastrostomi(OR:9,72).
Sonuç
Per-oral beslenmenin mümkün olmadığı hastalar için
en güvenli beslenme şekli PEG kateter vasıtasıyla enteral beslenmedir. PEG
uygulaması yapılamayan hastalarda cerrahi gastrostomi yapılabilir. Geri
dönüşsüz hastalıklarda NG aracılığıyla besleme yaparak uzun süre beklemek
yerine özellikle de nozokomiyal pulmoner enfeksiyon gelişmeden gastrostomi
yapılması yerinde olacaktır. Morbidite riskini daha da azaltmak için açık
cerrahi yerine, oldukça minimal invaziv bir teknik olarak 5mm tek kamera portu
ile uygulanan U dikiş laparoskopik gastrostomi tekniği tercih edilebilir.
Anahtar Kelimeler
Perkutan endoskopik gastrostomi Enteral beslenme Cerrahi gastrostomi Laparoskopik gastrostomi peg
Kaynakça
- (1) STAMM, M. Gastrostomy by a new method. Med News 1894; 65: 324–326.
- (2) Gauderer MW, Ponsky JL, Izant RJ. Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg 1980; 15: 872–5.
- (3) Beres A, Bratu I, Laberge JM. Attention to small details: big deal for gastrostomies. Semin Pediatr Surg. Epub ahead of print 2009. DOI: 10.1053/j.sempedsurg.2009.02.005.
- (4) Georgeson KE. Laparoscopic gastrostomy and fundoplication. Pediatr Ann 1993; 22: 675–7.
- (5) Alverdy J, Chi HS, Sheldon GF. The effect of parenteral nutrition on gastrointestinal immunity. The importance of enteral stimulation. Ann Surg 1985; 202: 681–4.
- (6) Deitch EA, Ma WJ, Ma L, et al. Protein malnutrition predisposes to inflammatory-induced gut-origin septic states. Ann Surg 1990; 211: 560-7; discussion 567-8.
- (7) Baeten C, Hoefnagels J. Feeding via nasogastric tube or percutaneous endoscopic gastrostomy. A comparison. Scand J Gastroenterol Suppl 1992; 194: 95–8.
- (8) Park RH, Allison MC, Lang J, et al. Randomised comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding in patients with persisting neurological dysphagia. BMJ 1992; 304: 1406–9.
- (9) Mekhail TM, Adelstein DJ, Rybicki LA, et al. Enteral nutrition during the treatment of head and neck carcinoma: is a percutaneous endoscopic gastrostomy tube preferable to a nasogastric tube? Cancer 2001; 91: 1785–90.
- (10) Evaristo-Méndez G, Rocha-Calderón CH. Factores de riesgo para neumonía nosocomial en pacientes con cirugía abdominal. Cir Cir 2016; 84: 21–27.
- (11) Wolkewitz M, Vonberg R, Grundmann H, et al. Risk factors for the development of nosocomial pneumonia and mortality on intensive care units: application of competing risks models. Crit Care 2008; 12: R44.
- (12) Van Dusen R, Radomski M, Vaziri K, et al. Comparison of complications following laparoscopic versus open gastrostomy. J Am Coll Surg 2013; 217: S14–S15.
- (13) Antoniou SA, Antoniou GA, Koch OO, et al. Laparoscopic versus open obesity surgery: a meta-analysis of pulmonary complications. Dig Surg 2015; 32: 98–107.
- (14) Antoniou SA, Antoniou GA, Koch OO, et al. Meta-analysis of laparoscopic vs open cholecystectomy in elderly patients. World J Gastroenterol 2014; 20: 17626–34.
- (15) Biondi A, Di Stefano C, Ferrara F, et al. Laparoscopic versus open appendectomy: a retrospective cohort study assessing outcomes and cost-effectiveness. World J Emerg Surg 2016; 11: 44.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Cerrahi |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 28 Haziran 2019 |
| Yayımlandığı Sayı | Yıl 2019 Cilt: 6 Sayı: 2 |
