RETROSPECTIVE EVALUATION OF LAPAROSCOPIC OBESITY SURGERY CASES APPLIED IN OUR HOSPITAL

Yıl 2021, , 282 - 286, 01.07.2021

Elif Büyükerkmen Tunzala Yavuz Ömer Sert , Elif Doğan Bakı , Murat Akıcı , Ahmet Yuksek , Remziye Sıvacı

https://doi.org/10.18229/kocatepetip.762856

Öz

OBJECTIVE: It was aimed to retrospectively investigate the patients undergoing laparoscopic obesity surgery in our hospital in the study.
MATERIAL AND METHODS: We analyzed patients' data who underwent laparoscopic obesity surgery by a single surgeon between February 1, 2014, and December 1, 2018. Demographic features, postoperative complications, hospital stay, postoperative discharge, and mortality were recorded.
RESULTS: A total of 89 patients, were operated over a 4 - years period. The mean age of the patients was 41 ± 11.44, and the mean Body Mass Indexes (BMI) were 46.26 ± 6.74. Sixty-six of the patients were female and 23 were male and 44.9 % of our patients had an additional disease. Nine percent of the patients had difficult intubation (intubated via fiberoptic bronchoscope), 67.4 % of the patients were sent to the surgery ward, 32.6 % were sent to the intensive care unit. Patients requiring intensive care unit was significantly higher in patients with BMI above 50 (p = 0.011). Nine percent of the patients had at least one postoperative complication whereas mortality was seen in 2.2 % of them. The mean surgery time of the patients was 120.09 ± 68.09 minutes and the mean hospital stay was 6.76 ± 4.62 days.
CONCLUSIONS: Obesity is a chronic progressive and life-threatening disease due to the accompanying diseases. In accordance with the literature, although the majority of patients are women and their average age is low, 44.9% of them have an additional disease. We believe that the examination of perioperative anesthesia and surgical practices, patient results, and complications will be important in increasing the success rate of patients undergoing laparoscopic sleeve gastrectomy.

Anahtar Kelimeler

Laparoscopy, Obesity, Anesthesia

HASTANEMİZDE UYGULANAN LAPAROSKOPİK OBEZİTE CERRAHİSİ VAKALARININ GERİYE DÖNÜK DEĞERLENDİRİLMESİ

Öz

AMAÇ: Bu çalışmada hastanemizde laparoskopik obezite cerrahisi uygulanan hastaların retrospektif olarak değerlendirilmesi amaçlandı.
GEREÇ VE YÖNTEM: Şubat 2014 ve Aralık 2018 arasında tek hekim tarafından obezite cerrahisi uygulanan olguların dosyaları incelendi. Demografik özellikler, postoperatif komplikasyonlar, hastane kalış süresi, postoperatif taburculuk, mortalite kaydedildi.
BULGULAR: 4 yıllık bir süreçte toplam 89 hasta opere edildi. Hastaların yaş ortalamaları 41±11,44, ortalama beden kitle indeksleri (BKİ) 46,26±6,74 idi. Hastaların 66’sı kadın, 23’ü erkekti ve bunların % 44,9’unda ek hastalık mevcuttu. Hastaların %9’u zor entubasyon (fiberoptik bronkoskop ile entübe edilen)olup %67,4’ü servise çıkarken, %32,6sı yoğun bakıma çıkarılmıştır. Yoğun bakım ihtiyacı BKI 50’nin üzerinde olan hastalarda anlamlı bir şekilde yüksekti (p=0,011). Hastaların %9’unde postoperatif komplikasyon görülürken, %2,2’sinde mortalite görülmüştür. Hastaların cerrahi süre ortalamaları 120,09±68,09 dakika olup hastane kalış süreleri 6,76±4,62 gün idi.
SONUÇ: Obezite beraberindeki hastalıklar nedeniyle kronik ilerleyici ve hayatı tehdit eden bir hastalıktır. Literatürle de uyumlu olarak hastaların çoğunluğunun kadın olması ve yaş ortalamaları düşük olmasına rağmen, %44,9’unda ek hastalık olması bunun göstergesidir. Laparoskopik sleeve gastrektomi uygulanacak hastaların perioperatif anestezi ve cerrahi uygulamalarının, hasta sonuçlarının ve komplikasyonların incelenmesinin başarı oranının artırılmasında önemli olacağı kanaatindeyiz.

Anahtar Kelimeler

laparoskopi, obezite, anestezi

Kaynakça

• 1. World Health Organization. Interim Report of the Commission on Ending Childhood Obesity. World Heal Organ. 2015. doi:ISBN 978 92 4 151006 6. (İnternet) https:// www.who.int/end-childhood-obesity/commission-ending-childhood-obesity-interim-report.pdf?ua=.Erişim Tarihi: 04.06.2020.
• 2. Rajendram R, Khan MF, Preedy VR. Metabolism and Pathophysiology of Bariatric Surgery: Nutrition, Procedures, Outcomes and Adverse Effects. In: Anesthesia for Bariatric Surgery. 1st edition, London;2017; 637-55.
• 3. Hossain P, Kawar B, El Nahas M. Obesity and diabetes in the developing world. A growing challenge. N Engl J Med 2007;356(3) :213 - 5.
• 4. Sağlık ve Sosyal Bakım Bilgi Merkezi. İngiltere Sağlık Araştırması - 2012 trend tabloları. Londra: Sağlık ve Sosyal Bakım Bilgi Merkezi, 2013. (İnternet) http: //www.hscic.gov.uk / catalogue / PUB13219. Erişim Tarihi: 04.06.2020.
• 5. Türk Endokrin ve Metabolizma Derneği, Obezite tanı ve tedavi klavuzu. http://www.temd.org.tr/admin/uploads/tbl_gruplar/20180525144116-2018-05-25tbl_gruplar144108.pdf.
• 6. Sabuncu T, Kiyici S, Eren MA, et al. Summary of Bariatric Surgery Guideline of the Society of Endocrinology and Metabolism of Turkey. Turkish Journal of Endocrinology & Metabolism 2017; 21(4): 140-7.
• 7. Türk Endokrin ve Metabolizma Derneği, Bariatrik Cerrahi Klavuzu. (İnternet) http://www.temd.org.tr/admin/uploads/tbl_gruplar/20180618095001-2018tbl_gruplar1b2cd981a1.pdf. Erişim Tarihi: 04.06.2020.
• 8. Pelosi P, Croci M, Ravagnan I, et al. The effects of body mass on lung volumes, respiratory mechanics, and gas exchange during general anesthesia. Anesth Analg 1998; 87 (3): 654-60.
• 9. Chau EHL, Mokhlesi B, Chung F. Obesity hypoventilation syndrome and anesthesia. Sleep Med Clin 2013; 8 (1): 135-47.
• 10. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: A systematic review and meta-analysis. J Am Med Assoc 2004; 292: 1724-37.
• 11. Candiotti K, Sharma S, Shankar R. Obesity, obstructive sleep apnoea, and diabetes mellitus: anaesthetic implications. Br J Anaesth. 2009; 103 (suppl_1): i23-i30.
• 12. Lakdawala MA, Bhasker A, Mulchandani D, et al. Comparison between the results of laparoscopic sleeve gastrectomy and laparoscopic roux-en-y gastric bypass in the Indian population: A retrospective 1 year study. Obes Surg 2010; 20(1): 1-6.
• 13. Yilmaz A, Taşpinar V, Sakçak I, et al. Bariatric surgery and anesthesia/a retrospective study. Turkiye Klin J Med Sci 2012; 32 (1) : 24-31.
• 14. Tuncalı B, Özvardar PY, Ayhan A, et al. Retrospective evaluation of patients who underwent laparoscopic bariatric surgery. Turk Anesteziyoloji ve Reanimasyon Dern Derg 2018;46(4): 297-304.
• 15. O’Keefe KL, Kemmeter PR, Kemmeter KD. Bariatric surgery outcomes in patients aged 65 years and older at an American society for metabolic and bariatric surgery center of excellence. Obes Surg 2010; 20: 1199-1205.
• 16. Carron M, Veronese S, Foletto M, et al. Sugammadex allows fast-track bariatric surgery. Obes Surg 2013; 23 (10): 1558-63.
• 17. Koffman BM, Greenfield LJ, Ali II, et al. Neurologic complications after surgery for obesity. Muscle and Nerve 2006; 33 (2): 166-76.