Dergiler / Ulusal Travma ve Acil Cerrahi Dergisi / 2008 / Cilt: 14 - Sayı: 1
Selective laparoscopic adhesiolysis in the management of acute and chronic recurrent adhesive bowel obstruction
- Sayfa
- 28–33
- DOI
- —
Özet
Laparoskopik adezyolizis adezyonlara ba¤l› ameliyat sonras› ince ba¤›rsak t›kan›kl›klar›n›n tedavisinde son dekadda popülarite kazanm›flt›r. Bu çal›flmada, laparoskopinin bu alanda uygulanabilirli¤ i, etkinli¤i ve güvenli¤ini araflt›r›ld› ve selektif adezyolizisin ayr›nt›lar› tart›fl›ld›. GEREÇ VE YÖNTEM Bu çal›flmaya yap›fl›kl›klara ba¤l›, akut veya kronik tekrarlayan ince ba¤›rsak t›kan›kl›¤› nedeniyle laparoskopik tedavi görmüfl hastalar dahil edildi. Hastalar belirli bir algoritmaya göre tedavi gördü. Konservatif tedavinin yetersiz kald›¤› hastalar ameliyata al›narak sönük/fliflkin ba¤›rsak geçiflinin oldu- ¤u bölgeye selektif laparoskopik adezyolizis uyguland›. Kronik tekrarlayan ataklar geçiren ve konservatif tedaviye yan›t vermifl hastalarda ameliyat öncesi enteroklizis uyguland› ve adezyolizis bu bulgular k›lavuzlu¤unda yap›ld›. Di¤er tan›lar› d›fllamak amac›yla tüm olgularda bilgisayarl› tomografi incelemesi yap›ld›. BULGULAR Ocak 1998 - Haziran 2007 tarihleri aras›nda 31 hastaya (22 kad›n, 9 erkek) laparoskopik adezyolizis yap›ld›. Ortalama yafl 48 (aral› k 20-80) idi. Enteroklizis k›lavuzlu¤unda laparoskopik adezyolizis 19 hastada uyguland›. On iki hastaya akut t›kan›kl›k nedeniyle laparoskopik adezyolizis uyguland›. Enteroklizis, bu görüntüleme yönteminin uyguland›¤› hastalar›n tümünde patolojik yap›fl›kl› k veya band› göstermeyi baflard›. Komplikasyon ve a盤a geçifl oran› %9,6 olarak gerçekleflti. Hastalar›n tümünde ameliyat sonras› dönemde oral al›m tolere edildi. Enteroklizis k›lavuzlu¤unda laparoskopik adezyolizis uygulanm›fl bir hastada ameliyat sonras› 34. günde konservatif tedaviye yan›t veren geçici subileus ata- ¤› oldu. Ortalama hastanede yat›fl süresi 4,1 gün (aral›k: 2-7) olarak gerçekleflti. Hastalar takiplerinde semptomsuz seyretmektedir. SONUÇ Ameliyat sonras› yap›fl›kl›klara ba¤l› ba¤›rsak t›kan›klar›nda laparoskopi uygulanabilir, güvenli ve etkin bir yöntemdir. Laparoskopi akut veya kronik olgularda olabildi¤ince selektif uygulanmal› d› r. Enteroklizis, kronik t›kan›kl›klarda selektif laparoskopi uygulanmas›na olanak veren yararl› bir görüntüleme yöntemidir.
Abstract
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 obstruct ion. Enteroclysis was able to demonst r ate the pathological adhesion or band in all of the patents who underwent this imaging technique. Conversion and complic at ion rates were 9.6%. The entire patients tolerated well oral intake post operat ively except one who had underwent enteroclysis- guided adhesiolysis; the pat ient pres e nted with transient sub il eus on post operative day 34 and responded well to conservat ive management. Mean hosp ital stay was 4.1 days (range: 2-7). The pat ients are free of symptoms on their follow-up. CONCLUSION Laparoscopy is feasible, safe and effective in postoperative adhesive disease. Laparoscopic adhesiolysis should be performed as selective as possible in acute and chronic cases. Enteroclysis is a helpful imaging modality for performing selective laparoscopic adhesiolysis in chronic obstruction.