Mide, duodenum ve safra yollarına erişimden ödün vermeden, seçilmiş hastalarda etkili kilo kaybını sağlayan bir yöntem: Vertikal bantlı gastroplasti – Roux-en-Y gastrojejunostomi

Öz

Amaç: Bu çalışmada, oluşturulan gastro-gastrik yol ile bariatrik cerrahi sonrası mide duodenum ve safra yollarının değerlendirilmesine olanak sağlayan vertikal bantlı gastroplasti ve Roux-en-Y gastrojejunostomi tekniğinin kilo kaybı üzerine etkilerinin değerlendirilmesi amaçlandı.

Yöntemler: Kliniğimizde 2003-2016 yılları arasında vertikal bantlı gastroplasti-Roux-en-Y gastrojejunostomi yapılmış ve 7 yıllık takiplerini tamamlayan toplam 24 hasta (ortalama yaş: 36.8 yıl (18 - 58 yıl), % 62.5 kadın) çalışmaya dahil edildi. Yapılan ameliyatın özellikleri, hastaların hastanede kalış süreleri, ameliyat sonrası komplikasyonlar ve kilo kaybı ile ilgili veriler kaydedildi.

Bulgular: Ortalama ameliyat süresi 180±45 dakika ve hastanede kalış süresi 6.0±1.0 gündü. Mortalite olmadı, sadece bir hasta (% 4,2) ameliyat sonrası birinci günde kanama nedeniyle tekrar ameliyat edildi. Hastaların en sık görülen şikayetleri, ameliyat sonrası ikinci ayda kaybolan erken bulantı ve kusma idi, 11 hastada (%45,83) görülmüştür. 24 hastanın 7'sinde (%29,2) operasyonun erken döneminde disfaji şikayeti vardı. Hastalarımızın takibinde gelişmiş marjinal ülser veya anastomoz ülseri tespit edilmedi. Vertikal bantlı gastroplasti-Roux En Y Gastroenterostomi yapılan hastalarımızın birinci, ikinci, üçüncü, beşinci ve yedinci yıllarının sonunda kaydedilen ortalama fazla kiloların kaybı yüzdesi sırası ile 68,1 ± 13,8, 71,3 ± 8,8, 70,8 ± 14,6, 68,2 ± 11,3 ve 61,4 ± 13,3’dür.

Sonuç: Bulgularımız üst gastrointestinal sistemin değerlendirilmesine, oluşturulan gastro-gastrik yol ile olanak sağlayan vertikal bantlı gastroplasti- Roux-en-Y gastrojejunostomi’nin kabul edilebilir düzeyde kilo kaybı sağlayarak, seçilmiş bazı hastalarda uygulanabilir bir cerrahi yöntem olduğunu ortaya koymaktadır.

Anahtar Kelimeler

• Obezite cerrahisi
• vertikal bantlı gastroplasti
• gastrik by-pass
• endoskopik girişimler

Vertical banded gastroplasty combined with Roux-en-Y gastrojejunostomy to enable effective weight loss without compromising access to stomach, duodenum and biliary tract for selected patients

Abstract

Aim: To evaluate the feasibility of vertical banded gastroplasty combined with Roux-en-Y gastric bypass as an operational gastro-gastric outlet technique with the potential to allow appropriate management of whole biliary and upper gastrointestinal tract after bariatric surgery without compromising weight loss.

Methods: This study included 24 patients (mean age: 36.8 years, range 18 to 58 years, 62.5% female) who had undergone vertical banded gastroplasty combined with Roux-en-Y gastric bypass between 2003 and 2016 in our clinic and had completed a 7-year postoperative follow up. Data on operative characteristics, length of hospital stay and follow up data on postoperative complications and weight loss were recorded for each patient.

Results: Mean operative time was 180±45 minutes while length of hospital stay was 6.0±1.0 days. There was no mortality, and only one patient (4.2%) was reoperated for hemorrhage on the first postoperative day. The most common patient complaints were early nausea and vomiting in 11 patients (45.83%), which disappeared in the second postoperative month, while 7 patients (29.2%) had dysphagia in the early postoperative period. No marginal ulcers or ulcers on anastomosis were found. Mean percentage of excess weight loss values recorded at the end of the first, second, third, fifth and seventh year following vertical banded gastroplasty combined with Roux-en-Y gastric bypass were 68.1±13.8 71.3±8.8 70.8±14.6, 68.2±11.3 and 61.4±13.3, respectively.

Conclusions: Our findings indicate the feasibility of vertical banded gastroplasty combined with Roux-en-Y gastric bypass as a bariatric surgical procedure providing better postoperative evaluation and management of the whole upper gastrointestinal system through the stomach window created with the band along with acceptable weight loss in selected patients.

Keywords

• Obesity surgery
• vertical banded gastroplasty
• gastric bypass
• endoscopic interventions

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