Ulus Travma Acil Cerrahi Derg. 2020; 26(5): 678-684 | DOI: 10.14744/tjtes.2020.14668

Malign mide çýkýþ obstrüksiyonu nedeniyle palyatif gastrojejunostomi uygulanan hastalarda mide bölücü cerrahinin mide boþalmasýna etkisi

Reyyan Yýldýrým¹, Bahar Candaþ², Arif Arif Usta¹, Serdar Türkyýlmaz¹, Adnan Çalýk¹, Ali Güner^1
1Karadeniz Teknik Üniversitesi Týp Fakültesi, Genel Cerrahi Anabilim Dalý, Trabzon
²Karadeniz Teknik Üniversitesi Saðlýk Bilimleri Fakültesi, Cerrahi Hastalýklar Hemþireliði Anabilim Dalý, Trabzon

AMAÇ: Malign mide çýkýþ týkanýklýðý palyatif tedavisinde konvansiyonel gastrojejunostominin palyatif etkinliði tartýþmalýdýr. Bu çalýþmanýn amacý, konvansiyonel gastrojejunostomi ile mide bölücü gastrojejunostominin sonuçlarýný karþýlaþtýrmak ve malign mide çýkýþ týkanýklýðý olan hastalarda cerrahi sonrasý gecikmiþ mide boþalmasýný etkileyen faktörleri araþtýrmaktýr.
GEREÇ VE YÖNTEM: Çalýþma grubu midenin bölünüp bölünmeme durumuna göre konvansiyonel gastrojejunostomi ve mide bölücü gastrojejunostomi olarak iki gruba ayrýldý. Tüm demografik veriler; hasta özellikleri ve gecikmiþ mide boþalma derecesi ile 30 günlük komplikasyonlarý içeren ameliyat sonrasý sonuçlar toplandý. Klinik sonuçlarýn karþýlaþtýrýlmasýnýn ardýndan, gecikmiþ mide boþalmasý için risk faktörleri regresyon modelleri kullanýlarak belirlendi.
BULGULAR: Elli üç hasta çalýþmaya alýndý. Otuz yedi hastaya konvansiyonel gastrojejunostomi, 16 hastaya ise mide bölücü gastrojejunostomi uygulandý. Hastalarýn demografik ve temel özellikleri gruplar arasýnda benzerdi. Konvansiyonel gastrojejunostomi grubunda 10 (%27) hastada grade B-C gecikmiþ mide boþalmasý mevcut iken, mide bölücü gastrojejunostomi grubunda hiçbir hastada bu durum gözlenmedi. Gruplar arasýnda hastanede yatýþ süresi ve komplikasyonlar açýsýndan fark yoktu. Çok deðiþkenli regresyon analizinde uzak metastaz varlýðý (OR=0.156, %95 GA 0.034–0.720, p=0.017) ve mide bölünmesi (OR=0.127, %95 GA 0.025–0.653, p=0.014) gecikmiþ mide boþalmasý için baðýmsýz faktörler olarak bulundu.
TARTIÞMA: Malign mide çýkýþ týkanýklýðý olan hastalarda, mide bölücü gastrojejunostomi konvansiyonel gastrojejunostomi ile karþýlaþtýrýldýðýnda, mide boþalmasýný iyileþtirerek olumlu klinik sonuçlar saðlayabilir.

Anahtar Kelimeler: Gecikmiþ mide boþalmasý, mide bölücü gastrojejunostomi; mide çýkýþ obstrüksiyonu.

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Efficacy of stomach-partitioning on gastric emptying in patients undergoing palliative gastrojejunostomy for malign gastric outlet obstruction

Reyyan Yýldýrým¹, Bahar Candaþ², Arif Arif Usta¹, Serdar Türkyýlmaz¹, Adnan Çalýk¹, Ali Güner^1
1Department of General Surgery, Karadeniz Technical University Faculty of Medicine, Trabzon-Turkey
²Department of Surgical Disease Nursing, Karadeniz Technical University Faculty of Health Sciences, Trabzon-Turkey

BACKGROUND: Palliative efficacy of conventional gastrojejunostomy in palliation of malignant gastric outlet obstruction is debatable. This study aims to compare the outcomes of conventional gastrojejunostomy and stomach-partitioning gastrojejunostomy and to explore the factors influencing the delayed gastric emptying after surgery in patients with malignant gastric outlet obstruction.
METHODS: The study subjects were divided into the following two groups based on whether the stomach was partitioned or not: Conventional gastrojejunostomy and stomach-partitioning gastrojejunostomy. All demographic data, patient characteristics, postoperative outcomes, including delayed gastric emptying grade and 30-day complications were collected. Following the comparison of the clinical outcomes, risk factors for delayed gastric emptying were determined by regression models.
RESULTS: Fifty-three patients were included in this study. Of these, 37 patients underwent conventional gastrojejunostomy, whereas 16 patients underwent stomach-partitioning gastrojejunostomy. Patient demographics and baseline characteristics were comparable between groups. Although 10 (27%) patients in the conventional gastrojejunostomy group had delayed gastric emptying grade B-C, no patient in the stomach-partitioning gastrojejunostomy group experienced this condition. There was no difference between the groups concerning hospital stay and complications. In multivariate regression analysis, having distant metastasis (OR=0.156, 95%CI 0.034–0.720, p=0.017) and stomach-partitioning (OR=0.127, 95%CI 0.025–0.653, p=0.014) were found as independent factors for the delayed gastric emptying.
CONCLUSION: In patients with malignant gastric outlet obstruction, compared with conventional gastrojejunostomy, stomach-partitioning may provide favorable clinical outcomes by improving gastric emptying.

Keywords: Delayed gastric emptying, gastric outlet obstruction; stomach-partitioning gastrojejunostomy.

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