Çocuklarda Tek Kesi Laparoskopik ve Açık Yaklaşım Gastrostomi Yöntemlerinin Karşılaştırılması

Year 2020, , 207 - 211, 30.12.2020

Murat Kabaklıoğlu , Murat Kaya

https://doi.org/10.18678/dtfd.790415

Abstract

Amaç: Bu çalışmanın amacı çocuklarda tek insizyonlu laparoskopik gastrostomi (single incision laparoscopic gastrostomy, SILG) ile açık cerrahinin karşılaştırılmasıdır.
Gereç ve Yöntemler: Ocak 2016 ve Mart 2020 tarihleri arasında laparoskopik ve açık gastrostomi ameliyatı geçiren çocuklar geriye dönük olarak değerlendirildi. Veriler hastanın demografik özelliklerine, ameliyat ve anestezi süresine, enteral beslenmeye başlama zamanına ve komplikasyonlara göre düzenlendi. Stamm prosedürü için, üst orta hat kesiği ile karın eksplore edildi ve ikinci bir kesiden mide tüpü geçirildi. SILG yönteminde sadece bir kesi yapıldı. Bir trokar içine bir kamera yerleştirildikten sonra, trokarın hemen yanına bir yakalayıcı yerleştirildi. Kesiden midenin bir kısmı çıkarıldı. Lümen içerisine görsel olarak bir foley kateter yerleştirildi.
Bulgular: Her iki cerrahi grup için ameliyat süreleri arasında istatistiksel olarak anlamlı fark yoktu (p=0,844); aynı durum anestezi süreleri için de geçerliydi (p=0,919). Tam enteral beslenmeye başlama ve ulaşma süresi iki grup arasında önemli ölçüde farklılık gösterdi (p=0,005). Genel olarak tüm komplikasyonlar değerlendirildiğinde açık cerrahi grubunda daha fazla komplikasyon saptandı (p=0,077) Her iki grupta da dikkat çekici sayıda (%65,6) idame problemi görüldü.
Sonuç: SILG, teknik olarak zorlayıcı olmayan ve laparoskopi deneyimi olan herhangi bir çocuk cerrahı tarafından uygulanabilen bir tekniktir. Trokar giriş yerinde primer laparoskopik gastrostomi, düşük postoperatif komplikasyon oranları nedeniyle malnütrisyonlu tüm çocuklarda kolay ve güvenli bir şekilde yapılabilir ve her yaştaki çocuklara uygulanabilir.

Keywords

Tek Kesi Laparoskopik Gastrostomi, Stamm Gastrostomi, çocuk

Comparison of Single Incision Laparoscopic and Classic Stamm Gastrostomy Methods in Children

Abstract

Aim: The aim of this study was to compare single incision laparoscopic gastrostomy (SILG) with open surgery in children.
Material and Methods: Children who underwent laparoscopic and open gastrostomy surgeries between January 2016 and March 2020 were retrospectively evaluated. The data were arranged according to the patient's demographics, duration of surgery and anesthesia, time to start enteral feeding, and complications. For Stamm procedure, the abdomen was explored with an upper midline incision and a gastric tube was passed through a second incision. In the SILG method, only one incision was made. After inserting a camera was placed into a trocar, then a grasper was placed just next to the trocar. A part of stomach was removed through the incision. A foley catheter was placed visually into the lumen.
Results: There was no statistically significant difference between operation times for both surgical groups (p=0.844); the same was true for anesthesia times (p=0.919). The time taken to initiate and reach full enteral nutrition differed significantly between two groups (p=0.005). In general, when all complications were evaluated, more complications were found in the open surgery group (p=0.077). A remarkable number of maintenance problems (65.6%) were observed in both groups.
Conclusion: SILG is a technique that is not technically demanding and can be performed by any pediatric surgeon with experience in laparoscopy. Primary laparoscopic gastrostomy at the trocar insertion site can be performed easily and safely in all children with malnutrition due to low postoperative complication rates and applicable for all ages of children.

Keywords

Single Incision Laparoscopic Gastrostomy, Stamm Gastrostomy, children

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