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SON 5 YILDA MORBİD OBEZİTE SEBEPLİ SLEEVE GASTREKTOMİ YAPILAN HASTALARIN POST OPERATİF ERKEN DÖNEM SONUÇLARININ DEĞERLENDİRİLMESİ

Year 2025, Volume: 26 Issue: 2, 156 - 161, 28.04.2025

İhsan Tümkaya , Murat Çilekar , Sezgin Yılmaz , Murat Akıcı , Sule Cilekar

https://doi.org/10.18229/kocatepetip.1453036

Abstract

AMAÇ: Obezite, Dünya Sağlık Örgütü (DSÖ) tarafından ‘Vücuttaki yağ birikiminin sağlığı bozacak boyuta ulaşması’ olarak tanımlanmaktadır. Günümüzde laparaskopik sleeve gastrektomi obezite tedavisinde kullanılan en sık cerrahi yöntemdir ve doğru yönetilmediği zaman beraberinde birçok komplikasyon getirmektedir. Stapler hattından kaçak gelişmesi, kanama ve pulmoner tromboemboli en ciddi erken dönem komplikasyonlar olarak görülmektedir. Biz bu çalışmamızda ameliyat sonrası erken dönemde ortaya çıkan komplikasyon oranlarımızı literatürler eşliğinde tartışarak araştırdık.
GEREÇ VE YÖNTEM: Genel Cerrahi Kliniği’nde 1 Ocak 2017 ile 1 Mart 2022 tarihleri arasında laparaskopik sleeve gastrektomi yapılan 335 hasta retrospektif olarak çalışmamıza dahil edilmiştir. Standart laparaskopik sleeve gastrektomi tekniği yapılan tüm hastaların 311 (%92,8)’inde fibrin yapıştırıcı kullanılmıştır. 317 (%94,6) hastaya 5 tane stapler, 18 (%5,4) hastaya 6 tane stapler kullanılmıştır. Postoperatif dönemde 1. aya kadar oluşan komplikasyonlar kayıt altına alınmıştır.
BULGULAR: Araştırmaya yaşları 18 ile 72 arasında değişen, 67’si erkek 268’i kadın hasta olmak üzere 335 hasta dahil edildi. Cerrahi sonrası %2,4 oranında kaçak, %0,6 oranında kanama, %0,6 oranında pulmoner tromboemboli görüldü. Hastalarda kullanılan fibrin yapıştırıcı ve stapler sayısı kaçak açısından istatistiksel olarak anlamlı değildi. Fibrin yapıştırıcı kullanılmayan hastalarda fibrin yapıştırıcı kullanılan hastalara göre istatiksel olarak anlamlı bir şekilde kanama daha yüksekti (p=0,018).
SONUÇ: Cerrahi sonrası kaçak, kanama ve pulmoner tromboemboli komplikasyon oranlarımızın literatür çalışmalarıyla uyumlu olduğu görüldü. Kullandığımız fibrin yapıştırıcının kaçak önleme konusundaki etkinliği tartışmalı olmakla birlikte kanama üzerine etkisi yüksek görülmüştür. Cerrahi tedavi yapılan hastalarda fibrin yapıştırıcının stapler hattından kanamayı etkili bir şekilde önlemesi açısından kullanılabileceği düşüncesindeyiz.

Keywords

Fibrin yapıştırıcı Kaçak Kanama

Ethical Statement

Bu çalışma Afyonkarahisar Sağlık Bilimleri Üniversitesi Klinik Araştırmalar Etik Kurulu tarafından 15.04.2022 tarihinde 2011-KAEK-2 etik kurul koduyla onay alınmıştır.

Supporting Institution

AFYONKOCATEPE SAĞLIK BİLİMLERİ ENSTİTÜSÜ

Project Number

1

Thanks

Asistanlığa başladığım ilk günden bugüne kadar yanımda olan değerli hocam ve tez danışmanım Doç. Dr. Murat ÇİLEKAR, Prof. Dr. Sezgin YILMAZ, Doç. Dr. Murat AKICI ve Doç. Dr. Şule ÇİLEKAR’a teşekkürlerimi sunarım.

References

  • 1. Yücel N. Kilolu ve Obez Kadınlarda Obezite ve Benlik Saygısı İlişkisinin Değerlendirilmesi, Yüksek Lisans Tezi, Marmara Üniversitesi, Sağlık Bilimleri Enstitüsü, İstanbul, 2008:10-2.
  • 2. Purnell JQ. Definitions, Classification, and Epidemiology of Obesty, South Dartmouth (MA): MD Text.com, Inc.; 2000-. https://www.ncbi.nlm.nih.gov/books/NBK279167/ (01.08.2022).
  • 3. Turkiye-Saglik-Arastirmasi-2019, https://data.tuik.gov.tr/ ,Erişim Tarihi:01.08.2022.
  • 4. Yip S, Plank LD, Murphy R. Gastric Bypass and Sleeve Gastrectomy for Type 2 Diabetes: A Systematic Reviewand Meta-analysis of Outcomes. Obes Surg [Internet]. 2013;23(12):1994–2003.
  • 5. Zafar SN, Felton J, Miller K, Wise ES, Kligman M. Staple Line Treatment and Bleeding After Laparoscopic Sleeve Gastrectomy. JSLS J Soc Laparoendosc Surg. 2018;22(4): e2018.00056.
  • 6. Felsenreich DM, Bichler C, Langer FB, Gachabayov M, Prager G. Sleeve Gastrectomy: SurgicalTechnique, Outcomes, and Complications. SurgTechnolInt. 2020;36:63-9.
  • 7. Bellanger DE, Greenway FL. Laparoscopic sleeve gastrectomy: 529 caseswithout a leak: short-term results and technical considerations. Obes Surg. 2011;21:146-50.
  • 8. Aydin T, Aras O, Karip B, et al. Staple Line Reinforcement Methods in Laparoscopic Sleeve Gastrectomy: Comparison of Burst Pressures and Leaks. 2015;19(3): e2015.00040.
  • 9. Sertaç U, Kağan K, Effect of fibrin glue or suture on leakage in patients under going laparoscopic sleeve gastrectomy, Niger J Clin Prac. 2018;21(9):1209-1212.
  • 10. Matteo U, Simone T, Giovanni C. Riccardo G., Use of fibrin glue in bariatric surgery: analysis of complications after laparoscopic sleeve gastrectomy on 450 consecutive patients, 2021;73(1):305-11.
  • 11. Mario M, Marco M, Paola M, Laparoscopic sleeve gastrectomy: efficacy of fibrin sealant in reducing postoperative bleeding. A randomized controlled trial, 2014;66(3): 197-201.
  • 12. Akıcı M, Çilekar M, Evaluation of Different Stapler Line Strengthening Techniques with Burst Pressures İn Patients Undergoing Sleeve Gastrectomy. An Experimental Study. Annali Italiani Di Chirurgia. 2020;91:201-6.
  • 13. Banescu B, Balescu I, Copaescu C. Postoperative Bleeding Risk after Sleeve Gastrectomy. A Two Techniques of Stapled Line Reinforcement Comparative Study in 4996 Patients. Chirurgia (Bucur). 2019;114(6): 693-703.
  • 14. Piotr M , Michał W, Michał P, Magdalena P. More stapler firings increase the risk of perioperative morbidity after laparoscopic sleeve gastrectomy, Video surgery Miniinv. 2018;13(1):88–94.
  • 15. Musella M, Milone M, Maietta P, et al. Laparoscopic sleeve gastrectomy: efficacy of fibrin sealant in reducing postoperative bleeding. A randomized controlled trial. Updat Surg. 2014;66(3):197–201.
  • 16. Piazza G, Goldhaber SZ. Acute pulmonary embolism: part II: treatment and prophylaxis. Circulation. 2006;114: 42-7.
  • 17. Singh K, Podolsky ER, Um S, Saba S, Saeed I, Aggarwal L, et al. Evaluating the safety and Efficacy of BMI-based preoperative administration of low-molecular-weight heparin in morbidly obese patients undergoing Roux- en-Y gastric bypass surgery. Obez Surg. 2012;22:47–51.
  • 18. Chan MM, Hamza N, Ammori BJ. Duration of surgery independently influences risk of venous thromboembolism after laparoscopic bariatric surgery. Surg Obes Relat Dis. 2013;9:88–93.
  • 19. Sakon M, Maehara Y, Yoshikawa H, Akaza H. Incidence of venous thromboembolism following major abdominal surgery: a multicenter, prospective epidemiological study in Japan. J Thromb Haemost 2006;4:581– 6.

EVALUATION OF EARLY POSTOPERATIVE OUTCOMES IN PATIENTS WHO UNDERWENT SLEEVE GASTRECTOMY FOR MORBID OBESITY OVER THE PAST FIVE YEARS

Year 2025, Volume: 26 Issue: 2, 156 - 161, 28.04.2025

İhsan Tümkaya , Murat Çilekar , Sezgin Yılmaz , Murat Akıcı , Sule Cilekar

https://doi.org/10.18229/kocatepetip.1453036

Abstract

OBJECTIVE: According to the World Health Organization (WHO), obesity is defined as 'the accumulation of excess fat in the body to a degree that may impair health.' Currently, laparoscopic sleeve gastrectomy is the most commonly performed surgical procedure for obesity treatment and, if not managed properly, may result in various complications. The most serious early postoperative complications include staple line leakage, bleeding, and pulmonary thromboembolism. This study examines the incidence of early postoperative complications in sleeve gastrectomy patients, with a discussion of relevant literature.
MATERIAL AND METHODS: This retrospective study included 335 patients who underwent laparoscopic sleeve gastrectomy at the General Surgery Clinic between January 1, 2017, and March 1, 2022. Fibrin sealant was applied in 311 patients (92.8%) who underwent the standard laparoscopic sleeve gastrectomy technique. Five staplers were used in 317 patients (94.6%), while six staplers were used in 18 patients (5.4%). Postoperative complications occurring within the first month were recorded.
RESULTS: This study included 335 patients (67 males, 268 females), aged between 18 and 72 years. Postoperatively, the leak rate was 2.4%, while both the bleeding and pulmonary thromboembolism rates were 0.6%. Neither the use of fibrin sealant nor the number of staplers had a statistically significant effect on leak rates. However, bleeding was significantly higher in patients who did not receive fibrin sealant compared to those who did (p = 0.018).
CONCLUSIONS: Our rates of post-surgical leaks, bleeding, and pulmonary thromboembolism were found to be consistent with the existing literature. While the effectiveness of fibrin sealant in preventing leaks remains debatable, its impact on bleeding has been observed to be significant. Fibrin sealant appears to be an effective measure in preventing bleeding from the staple line in patients undergoing surgical treatment.

Keywords

Fibrin sealant Leak Bleeding

Ethical Statement

This study was approved by the Afyonkarahisar Health Sciences University Clinical Research Ethics Committee on 15.04.2022 with the ethics committee code 2011-KAEK-2.

Supporting Institution

AFYONKOCATEPE SAĞLIK BİLİMLERİ ENSTİTÜSÜ

Project Number

1

Thanks

I extend my gratitude to my esteemed professor and thesis advisor Assoc. Prof. Dr. Murat ÇİLEKAR, Prof. Dr. Sezgin YILMAZ, Assoc. Prof. Dr. Murat AKICI and Assoc. Prof. Dr. Şule ÇİLEKAR, who have been by my side since the first day I started my residency.

References

  • 1. Yücel N. Kilolu ve Obez Kadınlarda Obezite ve Benlik Saygısı İlişkisinin Değerlendirilmesi, Yüksek Lisans Tezi, Marmara Üniversitesi, Sağlık Bilimleri Enstitüsü, İstanbul, 2008:10-2.
  • 2. Purnell JQ. Definitions, Classification, and Epidemiology of Obesty, South Dartmouth (MA): MD Text.com, Inc.; 2000-. https://www.ncbi.nlm.nih.gov/books/NBK279167/ (01.08.2022).
  • 3. Turkiye-Saglik-Arastirmasi-2019, https://data.tuik.gov.tr/ ,Erişim Tarihi:01.08.2022.
  • 4. Yip S, Plank LD, Murphy R. Gastric Bypass and Sleeve Gastrectomy for Type 2 Diabetes: A Systematic Reviewand Meta-analysis of Outcomes. Obes Surg [Internet]. 2013;23(12):1994–2003.
  • 5. Zafar SN, Felton J, Miller K, Wise ES, Kligman M. Staple Line Treatment and Bleeding After Laparoscopic Sleeve Gastrectomy. JSLS J Soc Laparoendosc Surg. 2018;22(4): e2018.00056.
  • 6. Felsenreich DM, Bichler C, Langer FB, Gachabayov M, Prager G. Sleeve Gastrectomy: SurgicalTechnique, Outcomes, and Complications. SurgTechnolInt. 2020;36:63-9.
  • 7. Bellanger DE, Greenway FL. Laparoscopic sleeve gastrectomy: 529 caseswithout a leak: short-term results and technical considerations. Obes Surg. 2011;21:146-50.
  • 8. Aydin T, Aras O, Karip B, et al. Staple Line Reinforcement Methods in Laparoscopic Sleeve Gastrectomy: Comparison of Burst Pressures and Leaks. 2015;19(3): e2015.00040.
  • 9. Sertaç U, Kağan K, Effect of fibrin glue or suture on leakage in patients under going laparoscopic sleeve gastrectomy, Niger J Clin Prac. 2018;21(9):1209-1212.
  • 10. Matteo U, Simone T, Giovanni C. Riccardo G., Use of fibrin glue in bariatric surgery: analysis of complications after laparoscopic sleeve gastrectomy on 450 consecutive patients, 2021;73(1):305-11.
  • 11. Mario M, Marco M, Paola M, Laparoscopic sleeve gastrectomy: efficacy of fibrin sealant in reducing postoperative bleeding. A randomized controlled trial, 2014;66(3): 197-201.
  • 12. Akıcı M, Çilekar M, Evaluation of Different Stapler Line Strengthening Techniques with Burst Pressures İn Patients Undergoing Sleeve Gastrectomy. An Experimental Study. Annali Italiani Di Chirurgia. 2020;91:201-6.
  • 13. Banescu B, Balescu I, Copaescu C. Postoperative Bleeding Risk after Sleeve Gastrectomy. A Two Techniques of Stapled Line Reinforcement Comparative Study in 4996 Patients. Chirurgia (Bucur). 2019;114(6): 693-703.
  • 14. Piotr M , Michał W, Michał P, Magdalena P. More stapler firings increase the risk of perioperative morbidity after laparoscopic sleeve gastrectomy, Video surgery Miniinv. 2018;13(1):88–94.
  • 15. Musella M, Milone M, Maietta P, et al. Laparoscopic sleeve gastrectomy: efficacy of fibrin sealant in reducing postoperative bleeding. A randomized controlled trial. Updat Surg. 2014;66(3):197–201.
  • 16. Piazza G, Goldhaber SZ. Acute pulmonary embolism: part II: treatment and prophylaxis. Circulation. 2006;114: 42-7.
  • 17. Singh K, Podolsky ER, Um S, Saba S, Saeed I, Aggarwal L, et al. Evaluating the safety and Efficacy of BMI-based preoperative administration of low-molecular-weight heparin in morbidly obese patients undergoing Roux- en-Y gastric bypass surgery. Obez Surg. 2012;22:47–51.
  • 18. Chan MM, Hamza N, Ammori BJ. Duration of surgery independently influences risk of venous thromboembolism after laparoscopic bariatric surgery. Surg Obes Relat Dis. 2013;9:88–93.
  • 19. Sakon M, Maehara Y, Yoshikawa H, Akaza H. Incidence of venous thromboembolism following major abdominal surgery: a multicenter, prospective epidemiological study in Japan. J Thromb Haemost 2006;4:581– 6.
There are 19 citations in total.

Details

Primary Language English
Subjects General Surgery
Journal Section Articles
Authors

İhsan Tümkaya 0000-0003-1674-9115

Murat Çilekar 0000-0001-9175-6791

Sezgin Yılmaz 0000-0003-0213-3758

Murat Akıcı 0000-0001-6739-0670

Sule Cilekar 0000-0001-8659-955X

Project Number 1
Publication Date April 28, 2025
Submission Date March 18, 2024
Acceptance Date January 14, 2025
Published in Issue Year 2025 Volume: 26 Issue: 2

Cite

APA Tümkaya, İ., Çilekar, M., Yılmaz, S., Akıcı, M., et al. (2025). EVALUATION OF EARLY POSTOPERATIVE OUTCOMES IN PATIENTS WHO UNDERWENT SLEEVE GASTRECTOMY FOR MORBID OBESITY OVER THE PAST FIVE YEARS. Kocatepe Tıp Dergisi, 26(2), 156-161. https://doi.org/10.18229/kocatepetip.1453036
AMA Tümkaya İ, Çilekar M, Yılmaz S, Akıcı M, Cilekar S. EVALUATION OF EARLY POSTOPERATIVE OUTCOMES IN PATIENTS WHO UNDERWENT SLEEVE GASTRECTOMY FOR MORBID OBESITY OVER THE PAST FIVE YEARS. KTD. April 2025;26(2):156-161. doi:10.18229/kocatepetip.1453036
Chicago Tümkaya, İhsan, Murat Çilekar, Sezgin Yılmaz, Murat Akıcı, and Sule Cilekar. “EVALUATION OF EARLY POSTOPERATIVE OUTCOMES IN PATIENTS WHO UNDERWENT SLEEVE GASTRECTOMY FOR MORBID OBESITY OVER THE PAST FIVE YEARS”. Kocatepe Tıp Dergisi 26, no. 2 (April 2025): 156-61. https://doi.org/10.18229/kocatepetip.1453036.
EndNote Tümkaya İ, Çilekar M, Yılmaz S, Akıcı M, Cilekar S (April 1, 2025) EVALUATION OF EARLY POSTOPERATIVE OUTCOMES IN PATIENTS WHO UNDERWENT SLEEVE GASTRECTOMY FOR MORBID OBESITY OVER THE PAST FIVE YEARS. Kocatepe Tıp Dergisi 26 2 156–161.
IEEE İ. Tümkaya, M. Çilekar, S. Yılmaz, M. Akıcı, and S. Cilekar, “EVALUATION OF EARLY POSTOPERATIVE OUTCOMES IN PATIENTS WHO UNDERWENT SLEEVE GASTRECTOMY FOR MORBID OBESITY OVER THE PAST FIVE YEARS”, KTD, vol. 26, no. 2, pp. 156–161, 2025, doi: 10.18229/kocatepetip.1453036.
ISNAD Tümkaya, İhsan et al. “EVALUATION OF EARLY POSTOPERATIVE OUTCOMES IN PATIENTS WHO UNDERWENT SLEEVE GASTRECTOMY FOR MORBID OBESITY OVER THE PAST FIVE YEARS”. Kocatepe Tıp Dergisi 26/2 (April 2025), 156-161. https://doi.org/10.18229/kocatepetip.1453036.
JAMA Tümkaya İ, Çilekar M, Yılmaz S, Akıcı M, Cilekar S. EVALUATION OF EARLY POSTOPERATIVE OUTCOMES IN PATIENTS WHO UNDERWENT SLEEVE GASTRECTOMY FOR MORBID OBESITY OVER THE PAST FIVE YEARS. KTD. 2025;26:156–161.
MLA Tümkaya, İhsan et al. “EVALUATION OF EARLY POSTOPERATIVE OUTCOMES IN PATIENTS WHO UNDERWENT SLEEVE GASTRECTOMY FOR MORBID OBESITY OVER THE PAST FIVE YEARS”. Kocatepe Tıp Dergisi, vol. 26, no. 2, 2025, pp. 156-61, doi:10.18229/kocatepetip.1453036.
Vancouver Tümkaya İ, Çilekar M, Yılmaz S, Akıcı M, Cilekar S. EVALUATION OF EARLY POSTOPERATIVE OUTCOMES IN PATIENTS WHO UNDERWENT SLEEVE GASTRECTOMY FOR MORBID OBESITY OVER THE PAST FIVE YEARS. KTD. 2025;26(2):156-61.
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