Efficacy of complex decongestive physiotherapy applied before and after gastric sleeve surgery in a case with secondary lymphedema: a case report

Öz

Objective: This case report aimed to determine the effectiveness of Complex Decongestive Physiotherapy (CDP) applied before and after sleeve gastrectomy (SG) in a case with secondary lymphedema related to ovarian cancer and to investigate the effect of CDP on body image, quality of life, and anxiety level. Methods: This case report was conducted with a 44-year-old female patient who had ovarian cancer related unilateral lymphedema. Thirty sessions of CDP were applied to the patient before and after SG. All measurements were performed before and after CDP. The severity of edema was evaluated by circumference measurement and percentage of water content (tissue dielectric constant). Body image, quality of life, and anxiety level were evaluated by the Body Image Scale (BIS), Lymphedema Quality of Life Scale (LYMQOL), and the State-Trait Anxiety Inventory (STAI), respectively. Results: The greatest reduction in circumference measurements between the extremities was observed at the middle point of the quadriceps muscle after SG (before CDP: 101.1cm→ after CDP: 60.8cm). It was observed that the largest decrease in left lower extremity subcutaneous fluid percentages was in the malleolus area (%35.54) and the leg (%36.84) with CDP applied before and after SG. The scores of the BIS, LYMQOL, and STAI following CDP applied after SG were 89, 2.27, and 46 points respectively. Conclusion: This case report showed that CDP applied before and after TMC is an effective method in reducing the severity of lymphedema and improving the body image, quality of life, and anxiety level. Randomized controlled studies should be planned to determine the effect of CDP applied before TMC on the success of post-surgical treatment in obese patients with lymphedema.

Anahtar Kelimeler

• Obesity
• Lymphedema
• Ovarian neoplasms

Sekonder lenfödemli bir hastada tüp mide cerrahisi öncesi ve sonrası uygulanan kompleks boşaltıcı fizyoterapinin etkinliği: vaka raporu

Öz

Amaç: Bu vaka sunumunun amacı, over kanseri ile ilişkili sekonder lenfödemi olan bir hastada tüp mide cerrahisi (TMC) öncesinde lenfödem şikayeti için uygulanan Kompleks Boşaltıcı Fizyoterapi (KBF) ile aynı hastada TMC sonrasında uygulanan KBF’nin etkisini incelemek ve KBF’nin beden algısı, yaşam kalitesi ve anksiyete seviyesi üzerine olan etkisini araştırmaktı. Yöntem: Bu vaka raporuna over kanseri ile ilişkili unilateral (sol) alt ekstremitesinde sekonder lenfödem gelişen 44 yaşındaki kadın hasta dahil edildi. Hastaya TMC öncesi ve TMC sonrası 30 seans KBF uygulandı. Tüm değerlendirmeler KBF uygulamasından önce ve sonra yapıldı. Ödem şiddeti çevre ölçümü ve doku altı sıvı yüzdesi (doku altı dielektrik sabiti) ölçümleri ile belirlendi. Hastanın beden algısı, yaşam kalitesi ve anksiyete düzeyi sırasıyla Beden Algısı Ölçeği (BAÖ), Lenfödem Yaşam Kalitesi Anketi (LYMQOL) ve Durumluk-Sürekli Kaygı Envanteri (STAI) kullanılarak değerlendirildi. Bulgular: Çevre ölçümlerinde en belirgin azalmanın TMC sonrası uygulanan KBF ile quadriceps kasının orta noktasında olduğu bulundu (KBF’den önce 101,1cm→KBF’den sonra 60,8cm). TMC öncesi ve sonrası uygulanan KBF ile sol alt ekstremite doku altı sıvı yüzdelerinde en çok azalmanın sırasıyla malleol (%35,54) ve bacaktaki (%36,84) ölçüm noktalarında olduğu görüldü. TMC sonrası uygulanan KBF ile BAÖ, LYMQOL ve STAI puanları sırasıyla 89, 2,27, 46 puan olarak bulundu. Sonuç: Bu vaka sunumu TMC öncesi ve sonrası uygulanan KBF’nin lenfödem şiddetini azaltmada ve beden algısını, yaşam kalitesini ve kaygı düzeyini iyileştirmede etkili bir yöntem olduğunu gösterdi. Obez lenfödemli hastalarda TMC öncesi uygulanan KBF’nin cerrahi sonrasındaki tedavinin başarısı üzerine olan etkisini belirlemek için randomize kontrollü çalışmalar planlanmalıdır.

Anahtar Kelimeler

• Obezite
• Lenfödem
• Over kanseri

Kaynakça

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