. 2008; 14(1): 28-33 | |||
Akut ve kronik tekrarlayan, ameliyat sonrası yapışıklıklara bağlı bağırsak tıkanıklıkların tedavisinde selektif laparoskopik adezyolizisKaya Sarıbeyoğlu1, Salih Pekmezci1, Uğur Korman2, Ece Kol1, Bilgi Baca1, Semra Günay31İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi, Acil Tıp Birimi, İstanbul2İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi, Radyodiganostik Anabilim Dalı, İstanbul 3Okmeydanı Eğitim Ve Araştırma Hastanesi, 4. Cerrahi Kliniği, İstanbul AMAÇ: Laparoskopik adezyolizis adezyonlara bağlı ameliyat sonrası ince bağırsak tıkanıklıklarının tedavisinde son dekadda popülarite kazanmıştır. Bu çalışmada, laparoskopinin bu alanda uygulanabilirliği, etkinliği ve güvenliğini araştırıldı ve selektif adezyolizisin ayrıntıları tartışıldı. GEREÇ-YÖNTEM: Bu çalışmaya yapışıklıklara bağlı, akut veya kronik tekrarlayan ince bağırsak tıkanıklığı nedeniyle laparoskopik tedavi görmüş hastalar dahil edildi. Hastalar belirli bir algoritmaya göre tedavi gördü. Konservatif tedavinin yetersiz kaldığı hastalar ameliyata alınarak sönük/şişkin bağırsak geçişinin olduğu bölgeye selektif laparoskopik adezyolizis uygulandı. Kronik tekrarlayan ataklar geçiren ve konservatif tedaviye yanıt vermiş hastalarda ameliyat öncesi enteroklizis uygulandı ve adezyolizis bu bulgular kılavuzluğunda yapıldı. Diğer tanıları dışlamak amacıyla tüm olgularda bilgisayarlı tomografi incelemesi yapıldı. Selective laparoscopic adhesiolysis in the management of acute and chronic recurrent adhesive bowel obstructionKaya Sarıbeyoğlu1, Salih Pekmezci1, Uğur Korman2, Ece Kol1, Bilgi Baca1, Semra Günay31Department Of General Surgery, Istanbul University Cerrahpaşa Medical Faculty, İstanbul2Department Of Radiology, Istanbul University Cerrahpaşa Medical Faculty, İstanbul 34th Department Of General Surgery, Okmeydanı Research And Training Hospital, Istanbul BACKGROUND: Laparoscopic adhesiolysis became popular in the last decade for the management of postoperative adhesive small bowel obstruction. This paper investigates the feasibility, effectiveness and safety of laparoscopy in this field; the details of a selective adhesolysis were discussed as well. METHODS: The patients who underwent laparoscopic management of acute or chronic recurrent adhesive bowel obstruction were included into the study. The patients were managed according to a specific algorithm. If the conservative management has failed, selective laparoscopic adhesiolysis to the transition zone of distended /collapsed bowel was performed. Patients, who were suffering from chronic recurrent obstruction attacks and those who tolerated oral intake, underwent preoperative enteroclysis studies and selective adhesiolysis was performed according to imaging findings. Computerized tomography was performed in all cases to exclude other diagnoses. RESULTS: Thirty-one patients (22 female, 9 male) underwent laparoscopic adhesiolysis from January 1998 to June 2007. The mean age was 48 (range: 20-80). Enteroclysis - guided laparoscopic adhesiolysis was performed in nineteen patients. Twelve patients underwent laparoscopic adhesiolysis for acute obstruction. Enteroclysis was able to demonstrate the pathological adhesion or band in all of the patents who underwent this imaging technique. Conversion and complication rates were 9.6%. The entire patients tolerated well oral intake postoperatively except one who had underwent enteroclysis-guided adhesiolysis; the patient presented with transient subileus on postoperative day 34 and responded well to conservative management. Mean hospital stay was 4.1 days (range: 2-7). The patients are free of symptoms on their follow-up. Kaya Sarıbeyoğlu, Salih Pekmezci, Uğur Korman, Ece Kol, Bilgi Baca, Semra Günay. Selective laparoscopic adhesiolysis in the management of acute and chronic recurrent adhesive bowel obstruction. . 2008; 14(1): 28-33 Sorumlu Yazar: Kaya Sarıbeyoğlu, Türkiye |
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