KORONER ARTER BAYPAS OPERASYONLARINDA OTOLOG VENA SAFENA MAGNA ÇIKARILMASINDA ENDOSKOPİK, TÜNEL VE STANDART YÖNTEMİN KARŞILAŞTIRILMASI

Yıl 2020, Cilt: 83 Sayı: 2, 119 - 126, 23.03.2020

İbrahim Erdinç Didem Melis Öztaş Mert Meriç Murat Uğurlucan Öztekin Oto

Öz

Amaç: Otolog Vena Saphena Magna (VSM) koroner arter cerrahisinde kullanılan en yaygın baypas materyalidir. Genellikle Vena Saphena Magna standart uzun medial bacak insizyonu ile hazırlanmakta olup; insizyon hattında iyileşme problemleri sıklıkla izlenmektedir. Bu çalışmada, otolog VSM çıkarılmasında endoskopik yöntem, klasik ve tünel yöntemlerinin karşılaştırması yapılmıştır. Gereç ve Yöntem: Koroner baypas ameliyatı olan 40 hasta randomize ve retrospektif olarak seçildi. 10 hastada endoskopik yöntem ile, 15 hastada tünel ve 15 hastada klasik yöntem ile VSM çıkarılmıştır. Çalışmada bacak insizyonu ile ilgili olarak postop hastanede kalış süresi, kullanılan antibiyoterapi, ek antibiyotik ihtiyacı, üst bacak çapı, sızıntı, hematom, açık yara bakım süresi, kültür antibiyogram, insizyon boyutu, komplikasyon yeri, maliyet, postoperatif şikayet, ortalama VSM çıkarma süresi, VSM uzunluğu, kapalı pansuman günü, elastik bandaj süresi, drenaj miktarı, postoperatif ağrı skorlaması karşılaştırılmıştır. Bulgular: Tünel ve endoskopik yöntem grubunda çalışma sonunda klasik gruba göre, insizyon uzunluğunda, postoperatif ağrıda, major komplikasyon gelişiminde, insizyonu kapama süresinde, insizyonu kapamada kullanılan sütür materyalinde azalma saptanmıştır. Bunun yanında mükemmel bir kozmetik sonuçla hasta memnuniyeti artmış, erken dönemde mobilizasyonda rahatlık sağlanmıştır. Sonuç: Klasik yönteme göre endoskopik teknik ve tünel yöntemi uygulanan hastalarda bacaktaki insizyon sorunlarının daha az görüldüğü ve hastanede kalış süresinin, kullanılan sütür materyali miktarı ve insizyonu kapama süresinin, insizyon uzunluğunun ve postoperatif ağrının daha az olduğu gözlenmiştir. Hastanın mobilize olma süresinin de kısaldığı saptanmıştır. Bu sonuçlara göre endoskopik ve tünel yöntemlerinin kullanımının klasik yönteme üstünlüğü göz önünde bulundurulmalıdır.

Anahtar Kelimeler

Koroner baypas, vena safena magna, minimal invaziv teknikler

THE COMPARISON OF STANDARD, ENDOSCOPIC AND TUNNEL HARVESTING OF AUTOLOG VENA SAPHENA MAGNA IN CORONARY ARTERY BYPASS GRAFTING OPERATIONS

Öz

Objective: Autologous vena saphena magna is the most common bypass material used in coronary artery surgery. It is generally prepared with a long medial leg incision, and so healing problems are often observed. In this study, we aimed to compare endoscopic, classical and tunnel techniques in saphen harvesting. Material and Method: Fourty patients, who were selected randomly and retrospectively, were included in the study. Endoscopic saphen harvesting was performed on 10 patients, the tunnel technique was performed on 15 patients and the classical method was performed on 15 patients. Postoperative hospital stay, antibiotics, additional antibiotic requirement, upper leg size, hematoma, open care time, culture antibiogram, incision size, complication site, cost, postoperative complaints, median vena saphena magna harvesting time, vena saphena magna length, closed dressing time, elastic bandage time, drenaige amount, postoperative pain scores (Visual Analogue Scale-VAS) were all factors compared regarding saphen insicion site. Results: In tunnel end endoscopic procedures; insicion length, postoperative pain, major complication rate, incision closure time, the sutur material reqired for closing incisions were lower than the classical technique group. Moreover, the level of patients’ satisfaction was increased due to perfect cosmetic results and ease of early mobilization. Conclusion: Comparing classical saphen harvesting techniques with endoscopic and tunnel methods, it was found that incision problems, length of hospital stay, sutur material amounts, incision closure time, incision length and postoperative pain were detected in lower numbers in endoscopic and tunnel methods. Depending on these factors, the patient’s mobilization time was shortened. According to these results, the superiority of the endoscopic and tunnel methods compared to the classical method should be considered.

Anahtar Kelimeler

Coronary bypass, vena saphena magna, minimally invasive techniques

Kaynakça

• 1. Folliguet TA, Le Bret E, Moneta A, Musumeci S, Laborde F. Endoscopic saphenous vein harvesting versus ‘open’ technique. A prospective study. Eur J of Cardiothorac Surg 1998;13:662-6.
• 2. Isgro F, Weisse U, Voss B, Kiessling AH, Saggau W. Minimally invasive saphenous vein harvesting.is there an improvement of the results with the endoscopic approach? Eur J Cardiothorac Surg 1999;16(Suppl. 2):58-60.
• 3. Lutz CW, Schlensak C, Lutter G, Schöllhorn J, Beyersdorf F. Minimal-invasive, video assisted vein harvesting for cardiac and vascular surgical procedures. Eur J Cardiothorac Surg 1997;12:519-21.
• 4. Hoenig SJ, Hodin RA, Novak G, Cohn WE. Videoscopic harvest of inferior epigastric artery. Ann Thorac Surg 1999;67:565-6.
• 5. Utley JR, Thomason ME, Wallace DJ, Mutch DW, Staton L, Brown V, et al. Preoperative corralates of impaired wound healing after saphenos vein excision. J Thorac Cardivasc Surg 1989;98:147-9.
• 6. Paletta CE, Huang DB, Fiore AC, Swartz MT, Rilloraza FL, Gardner JE. Major leg wound complications after saphenous vein harvest for coronary revascularization. Ann Thorac Surg 2000;70:492-7.
• 7. Slaughter MS, Gerchar DC, Pappas PS. Modified minimally invasive technique for greater saphenous vein harvesting. Ann Thorac Surg 1998;65:571-2.
• 8. Cable DG, Dearani JA, Pfeifer EA, Daly RC, Schaff HV. Minimally invasive saphenous vein harvesting:Endotelial integrity and early clinical results. Ann Thorac Surg 1998;66:139-43.
• 9. Coppoolse R, Rees W, Krech R, Hufnagel M, Seufert K, Warnecke H. Routinė minimal invasive vein harvesting reduces postoperative morbidity in cardiac bypass procedures. Clinical report of 1400 patients. Eur J Cardiothorac Surg 1999;16(suppl 2):61-6.
• 10. Kent KC, Bartek S, Kuntz KM, Anninos E, Skillman JJ. Prospective study of wound complications in continuous infrainguinal incisions after lower limb arterial reconstruction: incidence, risk factors, and cost. Surgery. 1996;119(4):378-83.
• 11. El-Akkawi AI, Holdflod Møller CJ, Olsen PS, Carranza CL. Saphenous vein harvesting techniques for coronary artery bypass grafting. Ugeskr Laeger. 2019 Jan 14;181(3).
• 12. Li JY, Wang SS, Lin FY, Tsai CH, Chu SH. Video-assisted endoscopic saphenous vein harvesting for coronary artery baypass grafting. J Formos Med Assoc 1998;97(12):819-25.
• 13. Davis Z, Jacobs HK, Zhang M, Thomas C, Castellanos Y. Endoscopic vein harvest for coronary artery bypass grafting: technique and outcomes. J Thorac Cardivasc Surg 1998;116:228-35.
• 14. Cusimano RJ, Dale L, Butany JW. Minimally invasive cardiac surgery for removal of the greater saphenous vein. Can J Surg 1996;39(5):386-8.
• 15. El Gamel A, Dyde J, Perks J, Shaw R. Should we stitch the subcutaneous fat layer following saphenous vein excision for coronary revascularization? Eur J Cardiothorac Surg 1994;8:162-4.
• 16. Stavridis GT, Bobos D, Matsouka F, Lacoumenta S, Alivizatos PA. Minimally invasive long saphenous vein harvesting using a laryngoscope. Heart Surg Forum 1998;1(1):37-40.
• 17. Allen KB, Griffith GL, Heimansohn DA, Robison RJ, Matheny RG, Schier JJ, et al. Endoscopic versus traditional saphenous vein harvesting: a prospective, randomized trial. Ann Thorac Surg 1998;66:26-32.
• 18. Newman RV, Lammle WG. Minimallly invasive vein harvest :New techniques with Old Tools. Ann Thorac Surg 1999;67:571-2.
• 19. Cusimano RJ, Dale L, Butany JW. Minimally invasive cardiac surgery for removal of the greater saphenous vein. Can J Surg 1996;39(5):386-8.
• 20. Lutz CW, Schlensak C, Lutter G, Schöllhorn J, Beyersdorf F. Minimal-invasive, video assisted vein harvesting for cardiac and vascular surgical procedures. Eur J Cardiothorac Surg 1997;12:519-21.
• 21. Fabricius AM, Diegeler A, Doll N, Weidenbach H, Mohr FW. Minimally invasive saphenous vein harvesting techniques:morphology and postoperative outcome. Ann Thorac Surg 2000;70:473-8.
• 22. Carrizo GJ, Livesay JJ, Luy L. Endoscopic harvesting of the greater saphenous vein for aortocoronary bypass grafting. Tex Heart Inst J 1999;26(2):120-3.
• 23. Johnson PR, Tan SL, Chin AK. Endoscopic femoralpopliteal/distal bypass grafting: a perliminary report. J Am Coll Surg 1998;186:331-6.
• 24. Shiang SW, Vendargon SJ, Hamid SRBGS. Conventional versus Minimally Invasive Vein Harvesting: A Clinical Audit of Wound Dehiscence Complications. J Coll Physicians Surg Pak. 2019;29(4):371-4.
• 25. Ma GT, Liu XR, Zhang CJ, Liu JZ, Miao Q, Jiang C, et al. Endoscopic Saphenous Vein Harvesting versus Open Vein Harvesting Techniques. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2015;37(4):420-3.