Pankreas Cerrahisi Sonrası Gastrik Disfonksiyon Yönetimi
Özet
Pankreas cerrahisi sonrası en sık görülen komplikasyon olan gecikmiş gastrik boşalma (GGB), morbiditeyi artıran ve hastanede yatış süresini uzatan önemli bir klinik sorundur. Cerrahi tekniklerdeki ilerlemelere rağmen, bu komplikasyon %15-60 oranında görülmeye devam etmekte ve mekanizması tam olarak açıklanamasa da motilin aktivitesinde azalma, sinir hasarı ve iskemik nedenler gibi multifaktöryel hipotezlerle ilişkilendirilmektedir. Tanı ve sınıflandırmada "International Study Group of Pancreatic Surgery" (ISGPS) kriterleri temel alınarak hastalar klinik bulgularına göre Evre A, B ve C olarak gruplandırılmaktadır. Risk faktörleri arasında yüksek vücut kitle indeksi, diyabet ve en önemlisi postoperatif pankreatik fistül (POPF) yer alırken, cerrahi tekniklerin (pilor koruyucu yaklaşım veya anastomoz yolları) etkisi halen tartışmalıdır. Tedavi süreci genellikle nazogastrik drenaj, prokinetik ilaçlar ve beslenme desteğini (enteral veya parenteral) kapsayan konservatif bir yaklaşımla yürütülmektedir. Özellikle klinik olarak anlamlı olan Evre B ve C vakalarında intraabdominal enfeksiyonlar ekarte edilmeli ve adjuvan tedavilerin gecikebileceği göz önünde bulundurulmalıdır.
Delayed gastric emptying (DGE), the most common complication after pancreatic surgery, is a significant clinical problem that increases morbidity and prolongs hospital stays. Despite advancements in surgical techniques, this complication persists at rates of 15-60%, and although its mechanism is not fully explained, it is associated with multifactorial hypotheses such as decreased motilin activity, nerve damage, and ischemic causes. In diagnosis and classification, patients are grouped as Grade A, B, and C based on clinical findings using the International Study Group of Pancreatic Surgery (ISGPS) criteria. Risk factors include a high body mass index, diabetes, and most importantly, postoperative pancreatic fistula (POPF), while the impact of surgical techniques such as pylorus-preserving approaches or anastomosis routes remains controversial. The treatment process is generally conducted with a conservative approach encompassing nasogastric drainage, prokinetic medications, and nutritional support (enteral or parenteral). Particularly in clinically significant Grade B and C cases, intra-abdominal infections must be ruled out, and it should be noted that adjuvant treatments may be delayed.
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