Yaşlı Hastalarda Laparoskopik ve Açık Apendektominin Karşılaştırılması: Tek Merkez Deneyimi

Abstract

Amaç: Akut apandisit acil cerrahide sık görülen patolojilerdendir. Genellikle genç yaşta görülen bir hastalıktır. Ortalama yaşam süresinin uzaması ile yaşlı hasta popu-lasyonunda akut apandisit görülme oranları giderek artmaktadır. Bu çalışmanın amacı, 65 yaş üstü akut apandisit nedeni ile cerrahi olarak tedavi edilen hastalarda laparos-kopik ve açık cerrahi yöntemlerin sonuçlarını karşılaştırmaktır. Gereç ve Yöntemler: 2011-2018 yılları arasında Sakarya Üniversitesi Tıp Fakültesi Eğitim ve Araştırma Has-tanesi’nde akut apandisit nedeni ile cerrahi tedavi uygulanan 65 yaş üstündeki olgular çalışmaya dahil edildi. Olgular uygulanan cerrahi yönteme göre laparaskopik veya açık apendektomi ve komplike veya nonkomplike apandisit olarak değerlendirilerek sınıflandırıldı. Tüm gruplar yaş ortalaması, cinsiyet, beyaz küre (WBC) düzeyleri, ko-morbid hastalık varlığı, ASA skoru, operasyon süresi, oral alımın başlama zamanı, hastanede kalış süresi, postoperatif yoğun bakım gereksinimi, komplikasyon varlığı ve mortalite açısından değerlendirildi Bulgular: 65 yaş üstü apendektomi yapılan 161 olgunun 98’i erkek (% 60,80), 63’ü kadındı (% 39,20). Olguların 109’una (% 67,70) açık apendektomi, 52’sine (% 32,29) laparoskopik apendektomi uygulandığı belirlendi. Açık operasyon uygulanan 109 olgunun 61’inin (% 55,91), laparoskopik apendektomi uygulanan 52 olgunun 22’sinin (% 42,32) komplike akut apandisit olduğu saptandı. Opere edilen olguların 24’ünde (% 14,94), kom-plikasyon geliştiği gözlendi. Komplikasyonlar açısından laparoskopik opere edilen gruplarla açık apendektomi grupları arasında anlamlı farklılık saptanmadı (P=0,873). Gruplar yaş, cinsiyet, yandaş hastalık, ASA skoru ve preoperatif laboratuvar değerleri açısından benzer özellikler göstermekteydi Sonuç: Laparoskopik apendektomi yaşlı ve komorbiditesi yüksek hasta populasyonunda güvenle uygulanabilir bir yöntemdir.

Keywords

• akut apandisit
• laparoskopi
• yaşlı hasta

Laparoscopy Versus Open Appendectomy for Elderly Patients: A Single-Center Experience

Abstract

Objective: Acute appendicitis rates are gradually increasing in the elderly people population with prolonged life expectancy. This study aims to compare applicability of laparoscopic and open surgical methods in patients treated surgically for acute appendicitis over 65 years of age. Materials and Methods: Patients over 65 years old who underwent surgical treatment for acute appendicitis at the Sakarya University Hospital between 2011-2018 were included in the study. The patients were clas-sified according to the surgical method applied as laparoscopic or open appendectomy and complicated or non-complicated appendicitis. All groups were evaluated in terms of mean age, gender, white blood cell (WBC) levels, presence of comorbid disease, ASA score, operation time, the onset of oral intake, duration of hospital stay, postoperative intensive care require-ment, presence of complications and mortality. Results: Of the 161 patients who underwent appendectomy over 65, 98 were male (% 60,80) and 63 were female (% 39,20). It was determined that open appendectomy was per-formed in 109 (% 67,70) of the cases, and laparoscopic appendectomy in 52 (% 32,29). It was determined that 61 (% 55,91) of 109 cases undergoing open surgery and 22 (% 42,32) of 52 cases undergoing laparoscopic appendectomy were compli-cated acute appendicitis. Complications were observed in 24 (% 14,94) of one hun-dred and fifty patients. In terms of complications, no significant difference was found between laparoscopically operated groups and open appendectomy groups (P=0,873). Conclusion: Laparoscopic appendectomy is considered as a safely feasible method in the popu-lation of elderly and high comorbid patients.

Keywords

• acute appendicitis
• laparoscopy
• elderly

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