Non-travmatik dalak hastalıklarında tek port laparoskopik, çoklu porttan laparoskopik ve açık splenektomin perioperatif sonuçlarının karşılaştırılması
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Dosyalar
Tarih
2017
Yazarlar
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Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş-Amaç: Minimal invaziv cerrahi birçok alanda olduğu gibi genel cerrahi pratiğinde de daha fazla hasta memnuniyeti ve daha az perioperatif komplikasyon nedeniyle son yıllarda cerrahlar tarafından artan bir oranla tercih edilmektedir. Splenektomi için de cerrahi tipi endikasyona göre farklılık göstermekle birlikte minimal invaziv cerrahiye doğru yönelim artmıştır. Tek porttan girişim görece yeni bir tekniktir ve konvansiyonel laparoskopiye ve açık girişime oranla perioperatif komplikasyonların daha az olduğu bildirilmiş olsa da her 3 tekniğin perioperatif sonuçlarını karşılaştıran çalışma sayısı fazla değildir. Bu çalışmada belirtilen 3 teknikle non-travmatik hastalıklarda uygulanan splenektominin perioperatif sonuçlarının karşılaştırılması amaçlanmıştır. Gereç-Yöntem: Ege Üniversitesi Genel Cerrahi Anabilim Dalı'nda Haziran 2011- Aralık 2016 yılları arasında non-travmatik nedenlerden dolayı hastanemizde splenektomi uygulanan 18-72 yaş aralığındaki 82 hastanın dosyaları rektospektif olarak incelendi. Bu hastaların perioperatif ve post-operatif kaydedilmiş olan verileri; tek port splenektomi, konvansiyonel laparoskopik splenektomi, açık splenektomi uygulanmış olanlar olarak 3 gruba ayrıldı. Bu 3 grup için de ameliyat endikasyonu, ASA skoru, intraoperatif komplikasyon, operasyon süresi, hastanede kalış süresi, cerrahi post-operatif komplikasyon, genel post-operatif komplikasyonlar istatistiksel olarak analiz edildi. Bulgular: AS uygulanan (grup 1) 38 hasta, LS uygulanan (grup 2) 34 hasta, TPLS uygulanan (grup 3) 10 hasta karşılaştırıldı. Her 3 grupta da cinsiyet, ortalama yaş ve ASA skorları arasında anlamlı fark yoktu. Yine her 3 grupta da intraoperatif kanama ve post-op komplikasyonlar arasında anlamlı fark yoktu. ITP nedeniyle opere olan hastalar : Grup 1'de : %26.4, Grup 2: %91.2, Grup: 3'te %80 idi. ( p1 ve p3 < 00.5). Grup 1 de ortalama ameliyat süresi 81 dk ± 17, grup 2 de 81 dk ±22 ve grup 3 te 97 dk ± 22 idi. ( p1 ve p3 >0.05 p2 <0.05) Hastanede kalış süresi grup 1 de 3.4 gün (±0.72), grup 2 de 3.1 gün ( ± 1.10) ve grup 3 te 2.5 gün ± (0.7) idi. ( p1 <0.05, p2 <0.05 ve p3< 0.05) Grup 2'de ki 2 hastada intraoperatif splenik ven yaralanması nedeniyle açık splenektomiye geçildi. Grup 3'teki 1 hastada diseksiyon zorluğu nedeniyle laparoskopik splenektomiye geçildi. Grup 2'deki bir hastada marsupializasyon sırasında ince barsak yaralanması gerçekleşti ve açık prosedüre geçildi. Tartışma ve Sonuç: Tek porttan laparoskopik splenektomi hem standart laparoskopik hem de açık splenektomiye güvenli ve alternatif bir yöntemdir.
Background and Aim; Minimally invasive surgery is preferred by surgeons in recent years due to more patient satisfaction and less perioperative complications in general surgery practice as it is in many areas. For splenectomy, the direction of surgery towards minimally invasive surgery is increased, although the surgical type differs according to the indications. Single-port procedure is a new technique, and although it is reported that perioperative complications are less with conventional laparoscopy and open procedure, the number of studies comparing the perioperative outcomes of all 3 techniques is not high. The aim of this study is to compare the perioperative outcomes of splenectomy performed by these 3 techniques in non-traumatic splenic diseases. Material and Method: Between June 2011 and December 2016 in Ege University General Surgery Department, a total of 82 patients (aged 18-72 years ) who underwent splenectomy in our hospital due to non-traumatic reasons were investigated recspectively. Patients were alienated into three groups according to the procedure type including single port splenectomy, multiple port laparoscopic splenectomy, open splenectomy. Peri-operative and post-operative recorded data of these patients; Operational indications, ASA score, intraoperative complication, duration of operation, duration of hospital stay, surgical post-operative complications and general post-operative complications were statistically analyzed for these 3 groups. Results: There were 38 patients in group 1, 34 patients in group 2 and 10 in group 3. There was no significant difference between sex, mean age and ASA scores in all 3 groups. There was no significant difference between intraoperative bleeding and post-op complications in all three groups. Patients who underwent surgery due to ITP were: in gruop 1 26.4%, Group 2: 91.2%, Group 3: 80%. (P1 and p3 > 0.05) The mean duration of operation in group 1 was 81 min ± 17, in group 2 81 min ± 22 and in group 3 te 97 min ± 22 ( p1 and p3 >0.05 p2 <0.05) The duration of hospital stay was 3.4 days (± 0.72) in group 1, 3.1 days (± 1.10) in group 2, and ± (0.7) in group 3 .(P1<0.05, p<>0.05 and p3 <0.05) In group 2, open splenectomy was performed because of intraoperative splenic venous injury in 2 patients. In Group 3, laparoscopic splenectomy was performed because of the difficulty of dissection. In Group 2 , in a patient during the marsupialization, small bowel injury occurred and the open procedure was performed. Conclusion: Single port laparoscopic splenectomy is a safe and effective alternative to both standard laparoscopic and open splenectomy.
Background and Aim; Minimally invasive surgery is preferred by surgeons in recent years due to more patient satisfaction and less perioperative complications in general surgery practice as it is in many areas. For splenectomy, the direction of surgery towards minimally invasive surgery is increased, although the surgical type differs according to the indications. Single-port procedure is a new technique, and although it is reported that perioperative complications are less with conventional laparoscopy and open procedure, the number of studies comparing the perioperative outcomes of all 3 techniques is not high. The aim of this study is to compare the perioperative outcomes of splenectomy performed by these 3 techniques in non-traumatic splenic diseases. Material and Method: Between June 2011 and December 2016 in Ege University General Surgery Department, a total of 82 patients (aged 18-72 years ) who underwent splenectomy in our hospital due to non-traumatic reasons were investigated recspectively. Patients were alienated into three groups according to the procedure type including single port splenectomy, multiple port laparoscopic splenectomy, open splenectomy. Peri-operative and post-operative recorded data of these patients; Operational indications, ASA score, intraoperative complication, duration of operation, duration of hospital stay, surgical post-operative complications and general post-operative complications were statistically analyzed for these 3 groups. Results: There were 38 patients in group 1, 34 patients in group 2 and 10 in group 3. There was no significant difference between sex, mean age and ASA scores in all 3 groups. There was no significant difference between intraoperative bleeding and post-op complications in all three groups. Patients who underwent surgery due to ITP were: in gruop 1 26.4%, Group 2: 91.2%, Group 3: 80%. (P1 and p3 > 0.05) The mean duration of operation in group 1 was 81 min ± 17, in group 2 81 min ± 22 and in group 3 te 97 min ± 22 ( p1 and p3 >0.05 p2 <0.05) The duration of hospital stay was 3.4 days (± 0.72) in group 1, 3.1 days (± 1.10) in group 2, and ± (0.7) in group 3 .(P1<0.05, p<>0.05 and p3 <0.05) In group 2, open splenectomy was performed because of intraoperative splenic venous injury in 2 patients. In Group 3, laparoscopic splenectomy was performed because of the difficulty of dissection. In Group 2 , in a patient during the marsupialization, small bowel injury occurred and the open procedure was performed. Conclusion: Single port laparoscopic splenectomy is a safe and effective alternative to both standard laparoscopic and open splenectomy.
Açıklama
Anahtar Kelimeler
Tek Port Splenektomi, Laparoskopik Splenektomi, Açık Splenektomi, Single Port Splenectomy, Laparoscopic Splenectomy, Open Splenectomy
