Beslenme Jejunostomisi; Özofagus Atrezili Olguların Tedavisinde Hayat Kurtarıcı Bir Uygulama

Yıl 2010, Cilt: 4 Sayı: 3, 165 - 170, 01.06.2010

Tuğrul Tiryaki Halil Atayurt Ziya Livanelioğlu Emrah Şenel Fatih Akbıyık

Öz

Amaç: Özofagus atrezisi onarımı sırasında beslenme jejunostomisi uygulamasının güvenilirliği, etkinliği ve komplikasyonlarının geriye dönük olarak değerlendirilmesi amaçlanmıştır. Metod: Çalışmamıza özofagus atrezisi onarımı sırasında primer gecikmiş onarım ve anastomoz sızdırması nedeni ile Witzel jejunostomi uygulaması yapılan 11 olgu alınmıştır. Olgularımız beslenme ve beslenmeyi tolere etme, iyileşme, kilo alma ve komplikasyonlar açısından değerlendirilmiştir. Bulgular: İki olguda beslenme sırasında kateter tıkanıklığı saptandı. Sekiz olguda yeterli kalori alımı beslenmeye başlamanın dördüncü gününde gerçekleşti. Üç olguda infüzyon hızını düşürerek izlemi gerektiren minör gastrointestinal komplikasyon gelişti. Olgularımız jejunostomi beslenmesinde ile ortalama 24 gün (14-45 gün) kaldılar. Hiçbir olguda tekrar kateter takılmasını gerektirecek ciddi bir komplikasyon gelişmedi. Beslenme jejunostomisine bağlı komplikasyondan kaybedilen hasta olmadı. Sonuçlar: Witzel tüp jejunostomi uygulaması özofagus atrezisi nedeni ile opere edilen olgularda beslenmenin sağlanması için etkili bir yöntemdir. Özofagusta yapılan anastomoza bağlı komplikasyon oluşan ya da gecikmiş primer onarım yapılacak olan hastalarda uzamış enteral beslenme bu yolla sağlanabilir. Bu tip olguların tedavisinde destekleyici önemli bir role sahiptir.

Anahtar Kelimeler

Beslenme jejunostomisi, özofagus atrezisi

FEEDING JEJUNOSTOMY; A LIFE SAVING PROCEDURE IN THE TREATMENT OF PATIENTS WITH ESOPHAGEAL ATRESIA

Öz

Purpose: Retrospective evaluation of the reliability, efficiency and complications of the feeding jejunostomy application in esophageal atresia repair is aimed. Method: 11 cases on whom Witzel jejunostomy is applied for delayed primary repair and anastomotic leakage in esophageal atresia treatment are included in our study. Our cases are evaluated on the basis of nutrition and tolerating the nutrition, recovery, gaining weight and complications. Findings: Catheter obstruction in the course of feeding was encountered in two cases. Adequate calory intake was realized on the fourth day of the feeding in eight cases. In three cases minor gastrointestinal complications developed which only required following by reduction of infusion speed. Our cases were kept on jejunostomy feeding for 24 days on average (14 to 45 days). In non of the cases a serious complication requiring a new catheter replacement developed. None of the patients were lost due to the complications of the feeding jejunostomy. Results: Witzel tube jejunostomy application is an effective method to maintain feeding in cases operated for esophageal atresia. Enteral feeding can be obtained by this way in patients with anastomotic complications or when delayed primary repair has to be done. It has a cardinal supportive role in the treatment of these kind of cases

Anahtar Kelimeler

Feeding jejunostomy, esophageal atresi

Kaynakça

• Ein SH, Shandling B, Wesson D, Filler RM. Esophageal atresia with distal tracheoesophageal fistula: associated anomalies and prognosis in the 1980’s. J Pediatr Surg 1989; 24:1055-1059.
• McKinnon LJ, Kosloske AM: Prediction and prevention of anastomotic complications of esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 1990;25:778-781.
• Choudhury SR, Ashcraft KW, Sharp RJ, Murphy JP, Synder CL, Sigalet DL. Survival of patients with esophageal atresia: inflıence of birth weight, cardiac anomaly, and late respiratory complications. J Pediatr Surg 1999;34: 70-73.
• Okada A, Usui N, Inoue M, Kawahara H, Kubota A, Imura K, Kamata S. Esophageal atresia in Osaka: a review of 39 years experience. J Pediat Surg 1997;32: 1570-1574.
• Gupta DK, Sharma S. Esophageal atresia: the total care in a high-risk population. Seminars in Pediatric Surgery. 2008;17:236-243.
• Bagolan P, Iacobelli Bd B, De Angelis P, di Abriola GF, Laviani R, Trucchi A, Orzalesi M, Dall’Oqlio L. Long gap esophageal atresia and esophageal replacement: moving toward a separation. J Pediatr Surg 32004;9:1084- 1090.
• Puri P, Ninan GK, Blake NS, Fitzgerald RJ, Guiney EJ, O’Donnell B. Delayed primary anastomosis for esophageal atresia 18 months’ to 11 years follow-up. J Pediatr Surg 1992; 27:1127-1130.
• Alexander F, Johanningman J, Martin LW: Staged repair improves outcome of high-risk premature infants with esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 1993;28:151-154.
• Schaarschmidt K, Willital GH, Jorch G, Kerremanns J. Delayed primary reconstruction of an esophageal atresia with distal esophagotracheal fistula in an infant weighing less than 500g. J Pediatr Surg 1992;27:1529-1531.
• Gupta V. Benefits versus risks: Aprospective audit Feding jejunostomy during esophagectomy. World J Surg 2009;33:1432-1438.
• Pickler RH, Best A, Crosson D The effect of feding experience on clinical outcomes in preterm infants J Perinatol 2009;29:124-129.
• Ben XM. Nutritional management of newborn infants: Practical guidelines. World J Gastroenterol 2008;14: 6133-6139.
• Healey PJ, Sawin RS, Hall DG, Schaller RT, Tapper D. Delayed primary repair of esophageal atresia with tracheoesophageal fistula: is it worth the wait? Arch Surg 1998;133: 552-556.
• Ito T, Sugito T, Nagaya M: Delayed primary anastomosis in poor-risk patients with esophageal atresia associated with tracheoesophageal fistula. J Pediatr Surg 1984;19: 243-247.
• Pohlson EC, Schaller RT, Tapper D: Improved survival with primary anastomosis in the low birth weight neonate with esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 1988;23:418-421.
• Filston HC, Chitwood WR Jr, Schkolne B, Blackmon LR. The Fogarty balloon catheter as an aid to management of the infant with esophageal atresia and tracheoesophageal fistula complicated by severe RDS or pneumonia. J Pediatr Surg. 1982;17:149-151.
• Fagelman KM, Boyarsky A. Temporary banding of the gastroesophageal junction in the critically ill neonate with esophageal atresia and tracheoesophageal fistula. Surgery. 1985;98:594-597.
• Ogita S, Tokiwa K, Takahashi T. Transabdominal closure of tracheoesophageal fistula: a new procedure for the management of poor- risk esophageal atresia with tracheoesophageal fistula. J Pediatr Surg. 1986;21:812-814.
• Randolph JG, Tunell WP, Lilly JR. Gastric division in the critically ill infant with esophageal atresia and tracheoesophageal fistula. Surgery. 1968;63:496-502.
• Smith D, Soucy P: Complications of long-term jejunostomy in children. J Pediatr Surg 1996;31: 787-790.