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

Yıl 2019, , 81 - 85, 01.08.2019

Tuğba Han Yılmaz , Hüseyin Gülay

https://doi.org/10.25000/acem.557828

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

Öz

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.

Anahtar Kelimeler

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

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