Preoperative Factors Affecting Health Quality Of Patients Undergone Surgery For Gastroesophageal Reflux Disease

Yıl 2017, Cilt: 31 Sayı: 1, 19 - 24, 26.05.2017

Turgut Anuk Şahin Kahramanca Ali Cihat Yıldırım Mahmut Can Yağmurdur

Öz

Objective: GORD(Gastroesophageal reflux disease)is
described as reflux of gastric content to esophagus leading to retrosternal
burn more than twice in a week.Cases resistant to anti-acid therapy and who
were complicated are candidates for anti-reflux surgery.In this study our aim
is to show and analyze preoperative factors affecting SF36 health survey scores
of patients undergone Laparoscopic Nissen Fundoplication(LNF) surgery for GORD
at postoperative sixth month.

Material and method: Patients who had
complaints of pain located on epigastric region,retrosternal burn and were
diagnosed as GORD,were undergone LNF;whose data of Helicobacter pylori(HP)
positivity,alkalen reflux gastritis(ARG) positivity,body mass
indices(BMI),diameters of hiatal hernia(HH) were recorded.27 patients were
excluded from the study who didn’t fill out the SF36 form, had some missing
information in their registration or follow-up files,and undergone conversion
fundoplication or retro surgery.The effects of these factors on SF36 Health
Survey form were analyzed on postoperative sixth month and compared.

Results: 22 patients had HP,19 patients had ARG
positivity.27 patients had BMI’s between 35-39.9kg/m².Female
patients had more sensitivity to pain(p=0,041),however patients with HP
positivity had more disability of emotional role statistically(p=0,039).There
was not statistically significant in SF36 form of patients with ARG
positivity(p>0.05).Patients with wider HH tent to have more response for
physical functions and pain(p=0.039, p=0.037). Patients with BMI’s between 30-34.9
kg/m2 tent to have more response to pain(p<0.001).

Conclusion: Our results show that LNF surgery could be
successfully performed for GORD treatment and SF36 test could be useful in
evaluation of surgical quality of GORD patients undergone LNF surgery especially
who have low BMI’s and large hiatal hernia.

Anahtar Kelimeler

Gastroesophageal reflux disease, Laparoscopic Nissen Fundoplication, SF36 scores

Gastro özefageal reflü hastalığı (GÖRH) cerrahisinde yaşam kalitesine etki eden preoperatif faktörler

Öz

Amaç: Mide içeriğinin, haftada ikiden fazla günde
özofagusa kaçarak retrosternal yanmaya yol açması, gastroözofageal reflü
hastalığı (GÖRH) olarak adlandırılır. Antiasit tedaviye direnç gösteren ve
komplikasyon gelişen olgularda anti reflü cerrahi uygulanmaktadır.
Çalışmamızda, GÖRH saptanıp, Laparoskopik Nissen Fundoplikasyonu (LNF) yapılan
hastalarda, postoperatif 6. ayda hasta tarafından doldurulan yaşam kalite
ölçeği (SF 36) skorlarına etki eden preoperatif faktörleri ortaya koymayı
amaçladık.

Gereç ve yöntem: Polikliniğe epigastrik bölgede ağrı,
retrosternal yanma şikayetleriyle başvurarak GÖRH tanısı alan ve LNF uygulanan
69 hastanın dosyasından yaş, cinsiyet, Helicobacter pylori (HP), alkalen reflü
gastrit (ARG) pozitifliği, vücut kitle indeksleri (VKİ), hiatus herni (HH)
çapları kaydedildi. SF 36 formunu doldurmayan, dosya kayıtlarında ve
takiplerinde eksiklik bulunan, konversiyon fundoplikasyon ve redo surgery
uygulanan 27 hasta çalışma dışı bırakıldı. Bu özelliklerin, postoperatif
altıncı ay SF 36 formlarındaki yaşam kalitesine etkileri incelendi.

Bulgular: Çalışmamızda 22 hastada HP, 19 hastada ARG
pozitifliği saptandı. Yirmi yedi hastada VKİ 35-39,9 kg/m2 olarak hesaplandı.
Kadın cinsiyette ağrıya yanıtın daha yüksek olduğu (p=0,041) olduğu
gözlenirken, HP pozitifliği olan grupta duygusal rol kısıtlılığında azalma (p=0,039)
daha anlamlıydı. ARG pozitifliği saptanan hastalarda, SF 36 formunda anlamlı
değişiklik gözlenmedi (p>0,05). HH çapı incelendiğinde, fiziksel fonksiyon
ve ağrıya, daha geniş HH’si olan hastalarda daha yüksek oranda yanıt alındığı
gözlendi (p= 0,039 ve p= 0,037). VKİ 30-34,9 kg/m2 arası olan grupta ağrıya
yanıtın daha iyi olduğu gözlendi (p<0,001).

Sonuç: Düşük VKİ’ye sahip, geniş hiatal hernisi
olan ve LNF uygulanan GÖRH’li hastalarda uygulanan cerrahinin
değerlendirilmesinde SF 36 yaşam kalite indeksinin kullanılabileceği ve
uygulanan LNF’nin başarılı sonuç verdiği sonucuna ulaştık.

Anahtar Kelimeler

Gastroözefageal reflü hastalığı, Laparoskopik Nissen fundoplikasyonu, SF 36 skoru

Kaynakça

• Referans1 Dobrucalı A. Gastroözofagial Reflü Hastalığı ve Teşhis ve Tedavide Karşılaşılan Sorunlar. Sempozyum Dizisi 2007;58:9-30.
• Referans2 Liaño AD, Yárnoz C, Artieda C, Artajona A, Fernández L, Ortiz H. Influence of psychopathological changes on quality of life after laparoscopic fundoplication for the treatment of gastroesophageal reflux. Diseases of the Esophagus 2010;23:8–12.
• Referans3 Lundell L, Miettinen P, Myrvold HE, et al. Continued (5-year) follow-up of a randomized clinical study comparing antireflux surgery and omeprazole in gastroesophageal reflux disease. J Am Coll Surg 2001;192:172–179.
• Referans4 Kamolz T, Granderathl FA, Bammerl T, et al. Mid- and long-term quality of life assessments after laparoscopic fundoplication and refundoplication: a single unit review of more than 500 antireflux procedures. Digestive and Liver Dis 2002;34:470-6.
• Referans5 Tosato F, Marano S, Mattacchione S, Luongo B, Mingarelli V, Campagna G. Quality of Life After Nissen-Rossetti Fundoplication. Surg Laparosc Endosc Percutan Tech 2012;3:205-9.
• Referans6 Balci D, Turkcapar AG. Assessment of quality of life after laparoscopic Nissen fundoplication in patients with gastroesophageal reflux disease. World J Surg 2007;31:116–121.
• Referans7 Stefanidis D, Hope WW, Kohn GP, Reardon PR, Richardson WS, Fanelli RD. Guidelines for surgical treatment of gastroesophageal reflux disease. Surg Endosc 2010;24:2647-2669.
• Referans8 Woodcock SA, Watson DI. Quality of life following laparoscopic anterior 90 degrees versus Nissen fundoplication: results from a multicenter randomized trial. World J Surg 2006;10:1856–1863.
• Referans9 Velanovich V. Comparison of symptomatic and quality of life outcomes of laparoscopic versus open antireflux surgery. Surgery 1999;126:782–788.
• Referans10 Bhandarwar AH, Kasat GV, Palep JH, Shaikh TA, Bakhshi GD, Nichat PD. Impact of laparoscopic Nissen’s fundoplication on response of disease specific symptoms and quality of life. Updates Surg (2013) 65:35–41.
• Referans11 Doğan İ. Gastroözofageal Reflü Hastalığı: Epidemiyoloji ve Klinik. Güncel Gastroenteroloji: 2009;77-80.
• Referans12 Adachi K, Mishiro T, Tanaka S, Hanada K and Kinoshita Y. Gender Differences in the Time-Course Changes of Reflux Esophagitis in Japanese Patients. Intern Med 2015:54;869-873.
• Referans13 Daugule I, Rumba I, Alksnis J. Helicobacter pylori infection among children with gastrointestinal symptoms: a higher prevlance of infection among patients with reflux oesophagitis. Acta Paediatrica 2007;96:1047–9.
• Referans14 Ashktorab H, Entezari O, Nouraie M, et al. Helicobacter pylori Protection Against Reflux Esophagitis. Dig Dis Sci 2012;57:2924–2928.
• Referans15 Nwokolo CU, Freshwater DA, O’Hare P, Randeva HS. Plasma ghrelin following cure of Helicobacter pylori. Gut 2003; 52: 637-40.
• Referans16 Dominguez-Mu-oz JE, Malfertheiner P. Effect of Helicobacter pylori infection on gastrointestinal motility, pancreatic secretion and hormone release in asymptomatic humans. Scand J Gastroenterol 2001;36:1141-7.
• Referans17 Fallone CA, Barkun AN, Friedman G, et al. Is Helicobacter pylori eradication associated with gastroesophageal reflux disease? Am J Gastroenterol 2000;95:914-920.
• Referans18 Nordenstedt H, Nilsson M, Johnsen R, Lagergren J, Hveem K: Helicobacter pylori infection and gastroesophageal reflux in a population-based study. Helicobacter 2007;12:16-22.
• Referans19 Emerenziani S, Rescio MP, Guarino MPL, and Cicala M. Gastro-esophageal reflux disease and obesity, where is the link? World J Gastroenterol 2013;19:6536-6539.
• Referans20 Khan A, Kim A, Sanossian C, Francois F. Impact of obesity treatment on gastroesophageal reflux Disease. World J Gastroenterol 2016;22:1627-1638.
• Referans21 Fraser J, Watson DI, O’Boyle CJ, Jamieson GG. Obesity and its effect on outcome of laparoscopic Nissen fundoplication. Dis Esophagus 2001;14:50-53.