P\u00ebrdorimi i gjer\u00eb i kirurgjis\u00eb laparoskopike t\u00eb obezitetit ka b\u00ebr\u00eb q\u00eb mjek\u00ebt e urgjenc\u00ebs dhe kirurg\u00ebt e p\u00ebrgjithsh\u00ebm t\u00eb p\u00ebrballen me komplikime akute dhe kronike t\u00eb kirurgjis\u00eb bariatrike. Pacient\u00ebt q\u00eb i jan\u00eb n\u00ebnshtruar operacionit bariatrik\u00eb duhet t\u00eb marrin nj\u00eb qasje me faza n\u00ebse hasin ndonj\u00eb urgjenc\u00eb.<\/p>\n\n\n\n
P\u00ebrpjekjet p\u00ebr reanimim jan\u00eb t\u00eb nj\u00ebjta si p\u00ebr pacient\u00ebt q\u00eb nuk i jan\u00eb n\u00ebnshtruar operacionit bariatrik\u00eb. Prandaj, konsultimi me nj\u00eb kirurg bariatri duhet t\u00eb sigurohet her\u00ebt. N\u00eb diagnoz\u00ebn diferenciale duhet t\u00eb merren parasysh komplikimet specifike t\u00eb operacionit.<\/p>\n\n\n\n
QASJA NDAJ PACIENTIT Q\u00cb I N\u00cbNSHTUAN KIRURGJIS\u00cb P\u00cbR OBIZETET<\/p>\n\n\n\n
Rr\u00ebshqitja akute e shiritit \u00ebsht\u00eb nj\u00eb nga nd\u00ebrlikimet m\u00eb t\u00eb shpeshta t\u00eb brezit t\u00eb stomakut (clamp). P\u00ebrpara se t\u00eb b\u00ebhen diagnoza t\u00eb tilla si \u201cftohje stomaku\u201d dhe \u201chelmim nga ushqimi\u201d te nj\u00eb pacient me brez q\u00eb ankohet p\u00ebr dhimbje dhe t\u00eb vjella, duhet v\u00ebrtetuar se ky nd\u00ebrlikim nuk ekziston. Gastrektomia e m\u00ebng\u00ebs dhe operacionet e bypass-it t\u00eb stomakut; Ajo mbart rrezikun e komplikimeve t\u00eb tilla si rrjedhja e staplerit ose gjakderdhja n\u00eb linj\u00ebn e staplerit, t\u00eb cilat mund t\u00eb jen\u00eb k\u00ebrc\u00ebnuese p\u00ebr jet\u00ebn.<\/p>\n\n\n\n
Operacionet e bypass-it gastrik dhe t\u00eb devijimit biliopankreatik mbartin rreziqe t\u00eb tilla si gjakderdhje, perforim ose stenoz\u00eb serioze, ve\u00e7an\u00ebrisht ul\u00e7er\u00eb margjinale n\u00eb linj\u00ebn e anastomoz\u00ebs. Obstruksionet e zorr\u00ebve mund t\u00eb ndodhin p\u00ebr shkak t\u00eb hernieve t\u00eb brendshme, ndonj\u00ebher\u00eb hernieve t\u00eb trokareve, intussusceptimit (obstruksioni si rezultat i hernies s\u00eb zorr\u00ebve n\u00eb vetvete), ngjitjeve, palosjeve dhe mpiksjes.<\/p>\n\n\n\n
N\u00eb rast urgjence, duhet t\u00eb ndiqen parimet ABC (Rruga ajrore \u2013 frym\u00ebmarrje dhe qarkullim) gjat\u00eb nd\u00ebrhyrjes tek pacienti bariatrik. Nj\u00eb histori e pacientit p\u00ebr procedur\u00ebn bariatrike t\u00eb kryer \u00ebsht\u00eb thelb\u00ebsore. Megjithat\u00eb, gjat\u00eb vler\u00ebsimit duhet t\u00eb sigurohet konsultimi me nj\u00eb kirurg bariatrik.<\/p>\n\n\n\n
Shpesh pacient\u00ebt nuk jan\u00eb n\u00eb dijeni t\u00eb detajeve t\u00eb procedur\u00ebs kirurgjikale q\u00eb i jan\u00eb n\u00ebnshtruar. Njohja e procedur\u00ebs bariatrike \u00ebsht\u00eb baza p\u00ebr fokusimin dhe vendosjen e nj\u00eb diagnoze.<\/p>\n\n\n\n
\u00c7rregullimi i shenjave vitale duhet t\u00eb sjell\u00eb n\u00eb mendje mund\u00ebsin\u00eb e embolis\u00eb pulmonare dhe seps\u00ebs. Shkaku m\u00eb i zakonsh\u00ebm i vdekjes n\u00eb mesin e pacient\u00ebve me kirurgji bariatrike \u00ebsht\u00eb embolia pulmonare. Shum\u00eb raste t\u00eb tromboembolizmit venoz zhvillohen edhe pas daljes nga spitali. Temperatura, presioni i ul\u00ebt i gjakut, takikardia, ulja e prodhimit t\u00eb urin\u00ebs, takipnea dhe hipoksia jan\u00eb simptomat m\u00eb t\u00eb r\u00ebnd\u00ebsishme t\u00eb infeksionit. K\u00ebto simptoma duhet t\u00eb paralajm\u00ebrojn\u00eb mjekun p\u00ebr shkaqet e infeksionit-seps\u00eb t\u00eb shkaktuar nga kirurgjia bariatrike. Prandaj, informacioni rreth operacionit do t\u00eb jet\u00eb nj\u00eb udh\u00ebzues n\u00eb diagnoz\u00ebn diferenciale t\u00eb komplikimeve septike t\u00eb lidhura me procedur\u00ebn.<\/p>\n\n\n\n
Ankesat si dhimbje barku, t\u00eb p\u00ebrziera dhe t\u00eb vjella, ve\u00e7an\u00ebrisht gjakderdhja nga sistemi tret\u00ebs, jan\u00eb nd\u00ebr komplikimet specifike t\u00eb operacionit. Simptomat e dehidrimit, pra t\u00eb mos marrjes s\u00eb l\u00ebngjeve t\u00eb mjaftueshme ose t\u00eb kompensimit t\u00eb humbjes, jan\u00eb takikardia, l\u00ebkura e that\u00eb, zbehja e mukozave dhe pak\u00ebsimi i sasis\u00eb s\u00eb urin\u00ebs. Reanimimi duhet t\u00eb filloj\u00eb menj\u00ebher\u00eb me l\u00ebngje t\u00eb p\u00ebrshtatshme pa glukoz\u00eb.<\/p>\n\n\n\n
Meqen\u00ebse k\u00ebta pacient\u00eb shpesh shfaqin tipare atipike, ata k\u00ebrkojn\u00eb v\u00ebmendje t\u00eb ve\u00e7ant\u00eb n\u00eb vler\u00ebsimin e shenjave dhe simptomave. Pozicioni i plot\u00eb i shtrir\u00eb duhet t\u00eb shmanget pasi l\u00ebkura dhe indet yndyrore t\u00eb tep\u00ebrta do t\u00eb shkaktojn\u00eb probleme me frym\u00ebmarrjen. N\u00ebse k\u00ebrkohet vendosja e tubit endotrakeal, anesteziologu duhet t\u00eb jet\u00eb vigjilent ndaj v\u00ebshtir\u00ebsive t\u00eb mundshme t\u00eb intubimit. Nuk duhet harruar se anatomia e sistemit t\u00eb sip\u00ebrm t\u00eb tretjes ndryshon kur vendoset nj\u00eb tub nazogastrik ose orogastrik.<\/p>\n\n\n\n
Komplikime akute specifike pas laparoskopis\u00eb s\u00eb rregullueshme gastrike<\/p>\n\n\n\n
Kirurgjia laparoskopike e brezit t\u00eb stomakut \u00ebsht\u00eb nj\u00eb nga metodat m\u00eb t\u00eb p\u00ebrdorura n\u00eb bot\u00eb. Probabiliteti i komplikimeve \u00ebsht\u00eb mjaft i ul\u00ebt n\u00eb periudh\u00ebn afatshkurt\u00ebr dhe afatmesme. Megjithat\u00eb, t\u00eb dh\u00ebnat afatgjata tregojn\u00eb nj\u00eb incidenc\u00eb m\u00eb t\u00eb lart\u00eb t\u00eb komplikimeve postoperative q\u00eb \u00e7ojn\u00eb n\u00eb ripozicionimin ose heqjen e shiritit. Komplikimet kryesore jan\u00eb rr\u00ebshqitja e brezit, zgjerimi akut ose kronik i qeses, erozioni dhe pengimi i p\u00ebrhersh\u00ebm ose i p\u00ebrs\u00ebritur i daljes.<\/p>\n\n\n\n
Rr\u00ebshqitja e brezit: Komplikacioni m\u00eb i zakonsh\u00ebm i brezit t\u00eb rregulluesh\u00ebm t\u00eb stomakut \u00ebsht\u00eb rr\u00ebshqitja. Zhvendosja e brezit; Zgjerimi kronik i qeses manifestohet si simptoma t\u00eb p\u00ebrparuara gradualisht t\u00eb intoleranc\u00ebs ushqimore, disfagjis\u00eb, uljes s\u00eb ndjenj\u00ebs s\u00eb ngopjes dhe kufizimit. Rr\u00ebshqitja akute e brezit karakterizohet nga dhimbje t\u00eb vazhdueshme abdominale, t\u00eb vjella dhe simptoma t\u00eb obstruksionit. Diagnoza radiologjike mund t\u00eb b\u00ebhet leht\u00ebsisht duke shtremb\u00ebruar orientimin e brezit n\u00eb radiografin\u00eb e thjesht\u00eb t\u00eb barkut. Nauze, t\u00eb vjella dhe kufizimi i marrjes nga goja mund t\u00eb \u00e7ojn\u00eb n\u00eb dehidrim t\u00eb r\u00ebnd\u00eb me ndryshime n\u00eb statusin kardiovaskular dhe n\u00eb shenjat vitale.<\/p>\n\n\n\n
Obstruksioni gastrik: Pengimi i shkaktuar nga nj\u00eb pickim i p\u00ebrtypur keq dhe i g\u00eblltitur shpejt mund t\u00eb \u00e7oj\u00eb n\u00eb disfagi akute dhe t\u00eb vazhdueshme. Kjo gjendje trajtohet n\u00eb m\u00ebnyr\u00eb konservative, e ngjashme me rr\u00ebshqitjen akute t\u00eb brezit. N\u00ebse trajtimi \u00ebsht\u00eb i suksessh\u00ebm, pacienti drejtohet t\u00eb marr\u00eb mb\u00ebshtetje ushqyese dhe t\u00eb vizitoj\u00eb kirurgun e tij\/saj bariatri.<\/p>\n\n\n\n
Migrimi i brezit zakonisht mund t\u00eb zbulohet gjat\u00eb kontrolleve radiologjike ose endoskopike. Edhe pse zakonisht nj\u00eb nd\u00ebrlikim kronik, infeksionet portuale zakonisht fillojn\u00eb n\u00eb muajt e par\u00eb t\u00eb operacionit. Trauma n\u00eb murin e pasm\u00eb t\u00eb stomakut gjat\u00eb operacionit dhe vendosja e shiritit t\u00eb ngusht\u00eb mund t\u00eb jet\u00eb shkaku i erozioneve t\u00eb hershme.<\/p>\n\n\n\n
Heqja e shiritit; \u00cbsht\u00eb i detyruesh\u00ebm p\u00ebr shkak t\u00eb komplikimeve t\u00eb tilla si gjakderdhja ose perforimi. Kur n\u00eb vendin e portit v\u00ebrehen shenja t\u00eb infeksionit akut t\u00eb portit si skuqje, \u00ebnjtje, abscesi ose formim fistula, n\u00ebse ka nj\u00eb absces, ai duhet t\u00eb drenohet urgjentisht dhe pacienti duhet t\u00eb referohet n\u00eb qendr\u00ebn bariatrike p\u00ebr ekzaminim dhe trajtim t\u00eb m\u00ebtejsh\u00ebm.<\/p>\n\n\n\n
Komplikime specifike akute pas operacionit laparoskopik t\u00eb gastrektomis\u00eb me m\u00ebng\u00eb (tuba e stomakut)<\/p>\n\n\n\n
Kirurgjia e gastrektomis\u00eb s\u00eb m\u00ebng\u00ebs, e cila \u00ebsht\u00eb p\u00ebrdorur p\u00ebr shum\u00eb vite si hapi i par\u00eb i kirurgjis\u00eb s\u00eb diversionit biliopankreatik dhe nd\u00ebrprerjes duodenale, tani konsiderohet nj\u00eb procedur\u00eb e pavarur. Gastrektomia laparoskopike me m\u00ebng\u00eb \u00ebsht\u00eb metoda m\u00eb e njohur e kirurgjis\u00eb bariatrike q\u00eb kryhet sot.<\/p>\n\n\n\n
Komplikimet e hershme q\u00eb dalin nga linja stapler jan\u00eb t\u00eb rralla, por nd\u00ebrlikimet m\u00eb t\u00eb frikshme. Sot, shum\u00eb procedura kirurgjikale, duke p\u00ebrfshir\u00eb gastrektomin\u00eb e m\u00ebng\u00ebs, mund t\u00eb kryhen si standard.<\/p>\n\n\n\n
Rrjedhjet e linj\u00ebs stapler<\/p>\n\n\n\n
Shkalla e rrjedhjeve pas gastrektomis\u00eb laparoskopike me m\u00ebng\u00eb varion n\u00eb var\u00ebsi t\u00eb seris\u00eb s\u00eb studimit dhe karakteristikave t\u00eb pacientit. Shenjat e peritonitit lokal ose t\u00eb p\u00ebrhapur q\u00eb shihen te nj\u00eb pacient i cili s\u00eb fundmi i \u00ebsht\u00eb n\u00ebnshtruar nj\u00eb operacioni bariatrik ka t\u00eb ngjar\u00eb p\u00ebr shkak t\u00eb nj\u00eb fistula t\u00eb von\u00eb. N\u00eb t\u00eb gjitha rastet e dyshimta duhet kryer tomografi.<\/p>\n\n\n\n
Tomografia q\u00eb do t\u00eb merret zakonisht tregon tre fotografi t\u00eb mundshme;<\/p>\n\n\n\n
Fistula e linj\u00ebs kryesore t\u00eb nivelit t\u00eb lart\u00eb dhe akumulimi i l\u00ebngut subdiafragmatik t\u00eb majt\u00eb n\u00eb kryq\u00ebzimin ezofagogastrik<\/p>\n\n\n\n
Akumulimi i l\u00ebngut perigastrik n\u00eb indin dhjamor perigastrik af\u00ebr vij\u00ebs s\u00eb staplerit pa flluska ajri dhe rrjedhje t\u00eb materialit kontrasti<\/p>\n\n\n\n
Rrjedhje t\u00eb shumta dhe akumulim i p\u00ebrhapur i l\u00ebngjeve<\/p>\n\n\n\n
Rrjedhjet trajtohen me sukses me nj\u00eb shum\u00ebllojshm\u00ebri t\u00eb gjer\u00eb nd\u00ebrhyrjesh t\u00eb kryera tek pacienti duke p\u00ebrdorur metoda endoskopike dhe kateter\u00eb t\u00eb vendosur p\u00ebrmes l\u00ebkur\u00ebs n\u00ebn tomografin\u00eb e kompjuterizuar. Arsyeja m\u00eb e r\u00ebnd\u00ebsishme e d\u00ebshtimit k\u00ebtu \u00ebsht\u00eb vonesa n\u00eb diagnoz\u00ebn dhe trajtimi i von\u00eb. Vonesa n\u00eb diagnoz\u00eb mund t\u00eb ndodh\u00eb p\u00ebr shkak t\u00eb ndjekjes s\u00eb dob\u00ebt t\u00eb pacientit, ose p\u00ebr shkak t\u00eb neglizhenc\u00ebs s\u00eb vet\u00eb pacientit, p\u00ebr t’i shp\u00ebtuar kontrollit ose p\u00ebr t\u00eb mos ardhur te kirurgu q\u00eb kreu operacionin p\u00ebr nj\u00eb kontroll. Prandaj, \u00ebsht\u00eb jetike q\u00eb k\u00ebto operacione t\u00eb kryhen nga ekipe q\u00eb kujdesen p\u00ebr pun\u00ebn e tyre, ndjekjen dhe trajtimin e plot\u00eb postoperativ, si dhe kan\u00eb aft\u00ebsin\u00eb dhe p\u00ebrvoj\u00ebn p\u00ebr t\u00eb kryer t\u00eb gjitha llojet e nd\u00ebrhyrjeve pas diagnostikimit. Shum\u00eb metoda p\u00ebrdoren n\u00eb m\u00ebnyr\u00eb endoskopike, t\u00eb tilla si kap\u00ebse gastrike (OTSC), stent ezofagoduodenal, drenazh i brendsh\u00ebm dhe aplikimi i botoksit t\u00eb pilorusit. N\u00eb k\u00ebt\u00eb m\u00ebnyr\u00eb, rrjedhjet mbyllen n\u00eb 6-8 jav\u00eb. Rrjedhjet nga m\u00ebng\u00ebt q\u00eb nuk mund t\u00eb korrigjohen me metod\u00ebn endoskopike duhet t\u00eb korrigjohen me kirurgji. P\u00ebr k\u00ebt\u00eb q\u00ebllim, opsionet e trajtimit jan\u00eb riparimi par\u00ebsor, shnd\u00ebrrimi n\u00eb kirurgji bypass, fistulojejunostomy dhe operacionet totale t\u00eb gastrektomis\u00eb. Pika e r\u00ebnd\u00ebsishme k\u00ebtu \u00ebsht\u00eb diagnoza e hershme dhe fillimi i trajtimit sa m\u00eb shpejt t\u00eb jet\u00eb e mundur.<\/p>\n\n\n\n
Stenoza pas m\u00ebng\u00ebs gastrike<\/p>\n\n\n\n
Kalibrimi i gastrektomis\u00eb s\u00eb m\u00ebng\u00ebs p\u00ebrmes nj\u00eb tubi shum\u00eb t\u00eb ngusht\u00eb \u00e7on n\u00eb zhvillimin e stenoz\u00ebs s\u00eb mesme t\u00eb stomakut n\u00eb nj\u00eb shkall\u00eb prej 4 p\u00ebrqind. N\u00eb k\u00ebta pacient\u00eb, shpesh mund t\u00eb v\u00ebrehen t\u00eb vjella t\u00eb vazhdueshme dhe intoleranc\u00eb ushqimore. Pas trajtimit konservativ t\u00eb dehidrimit, pacient\u00ebt duhet t\u00eb d\u00ebrgohen n\u00eb qendr\u00ebn bariatrike p\u00ebr zgjerim endoskopik. N\u00eb p\u00ebrgjith\u00ebsi, mjaftojn\u00eb 3-4 zgjerime endoskopike q\u00eb nuk k\u00ebrkojn\u00eb shtrimin n\u00eb spital. N\u00eb rast t\u00eb zgjerimit t\u00eb pasuksessh\u00ebm, mund t\u00eb k\u00ebrkohet rishikim efektiv i bypass-it t\u00eb stomakut.<\/p>\n\n\n\n
Komplikime akute specifike q\u00eb mund t\u00eb shfaqen pas bypass-it gastrik<\/p>\n\n\n\n
Bypass-i gastrik \u00ebsht\u00eb ve\u00e7an\u00ebrisht i popullarizuar n\u00eb Amerik\u00ebd obezitenin cerrahi tedavisinde alt\u0131n standart olarak kabul edilir. Lineer staplerler kullan\u0131larak yemek borusunun hemen alt\u0131nda 25-30 ml hacminde k\u00fc\u00e7\u00fck bir mide po\u015fu olu\u015fturulur.<\/p>\n\n\n\n
Rrjedhje anastomotike<\/p>\n\n\n\n
Rrjedhja anastomotike pas bypass-it gastrik konsiderohet gjithashtu nj\u00eb nd\u00ebrlikim k\u00ebrc\u00ebnues p\u00ebr jet\u00ebn. Rrjedhja e hershme ose e vonshme mund t\u00eb paraqes\u00eb nj\u00eb pasqyr\u00eb klinike q\u00eb varion nga rrjedhja subklinike n\u00eb seps\u00eb. Gjat\u00eb faz\u00ebs s\u00eb diagnostikimit, duhet t\u00eb b\u00ebhet film pasazh me gastrografin\u00eb, tomografi dhe analiz\u00eb gjaku.<\/p>\n\n\n\n
Trajtimi kirurgjik urgjent duhet t\u00eb merret parasysh n\u00eb pacient\u00ebt hemodinamikisht t\u00eb paq\u00ebndruesh\u00ebm me simptoma t\u00eb r\u00ebnda dhe t\u00eb vazhdueshme. Barku duhet t\u00eb lahet shum\u00eb dhe duhet t\u00eb vendosen kullues t\u00eb shumt\u00eb. Krahasuar me gastrektomin\u00eb me m\u00ebng\u00eb, rrjedhjet e bypass mbyllen shum\u00eb m\u00eb shpejt dhe m\u00eb leht\u00eb pasi presioni n\u00eb zon\u00ebn e anastomoz\u00ebs \u00ebsht\u00eb m\u00eb i ul\u00ebt.<\/p>\n\n\n\n
Ul\u00e7era margjinale e komplikuar<\/p>\n\n\n\n
Ul\u00e7era margjinale \u00ebsht\u00eb nj\u00eb ul\u00e7er\u00eb peptike q\u00eb shfaqet n\u00eb mukoz\u00ebn n\u00eb skajin e anastomoz\u00ebs gastrojejunale. Mund t\u00eb shihet her\u00ebt (1-3 muaj) ose von\u00eb pas bypass-it gastrik.
Simptomat m\u00eb t\u00eb zakonshme jan\u00eb dhimbja dhe gjakderdhja.<\/p>\n\n\n\n
Komplikime specifike akute pas diversionit biliopankreatik dhe kalimit duodenal<\/p>\n\n\n\n
Diversioni biliopankreatik \u00ebsht\u00eb procedura metabolike bariatrike m\u00eb efektive n\u00eb krahasim me teknikat e tjera. P\u00ebr shkak t\u00eb ndryshimeve anatomike dhe fiziologjike q\u00eb ndodhin n\u00eb sistemin e tyre tret\u00ebs, k\u00ebta pacient\u00eb k\u00ebrkojn\u00eb v\u00ebmendje t\u00eb ve\u00e7ant\u00eb, ve\u00e7an\u00ebrisht n\u00eb situata emergjente.<\/p>\n\n\n\n
Shum\u00eb komplikime jan\u00eb situata q\u00eb vihen re n\u00eb fillim dhe k\u00ebrkojn\u00eb v\u00ebmendjen e kirurgut t\u00eb p\u00ebrgjithsh\u00ebm n\u00eb urgjenc\u00eb. Shpesh \u00ebsht\u00eb e mundur t\u00eb stabilizohen pacient\u00ebt p\u00ebr transferim n\u00eb nj\u00eb qend\u00ebr bariatrike.<\/p>\n\n\n\n
Komplikime akute specifike pas plikimi gastrik laparoskopik<\/p>\n\n\n\n
Palosja e stomakut (palosja e stomakut) \u00ebsht\u00eb nj\u00eb operacion q\u00eb sot ka nisur t\u00eb braktiset p\u00ebr shkak t\u00eb rezultateve t\u00eb pasuksesshme dhe shkall\u00ebve t\u00eb larta t\u00eb rifitimit t\u00eb pesh\u00ebs. Njohurit\u00eb dhe p\u00ebrvoja n\u00eb lidhje me menaxhimin e komplikimeve t\u00eb saj jan\u00eb t\u00eb kufizuara.Obstruksioni gastrik \u00ebsht\u00eb arsyeja m\u00eb e zakonshme p\u00ebr rioperim. Fillimisht mund t\u00eb provohet trajtimi konservativ (anti-edema dhe barna q\u00eb mbrojn\u00eb stomakun). N\u00ebse t\u00eb vjellat nuk p\u00ebrmir\u00ebsohen, shtresa q\u00eb shkakton pengimin duhet t\u00eb hapet me endoskopi.<\/p>\n\n\n\n
Komplikime akute q\u00eb nuk lidhen me llojin e kirurgjis\u00eb<\/p>\n\n\n\n
Gjakderdhje: Gjakderdhja mund t\u00eb rezultoj\u00eb nga linjat kryesore ose nga nj\u00eb fokus tjet\u00ebr. Gjakderdhja n\u00eb vendin e trokarit, d\u00ebmtimi i shpretk\u00ebs ose d\u00ebmtimi i m\u00ebl\u00e7is\u00eb i lidhur me t\u00ebrheqjen jan\u00eb burime t\u00eb rralla, por t\u00eb mundshme t\u00eb gjakderdhjes. K\u00ebto komplikime zakonisht ndodhin brenda 48 or\u00ebve t\u00eb para pas operacionit. Gjat\u00eb k\u00ebtij procesi, pacienti \u00ebsht\u00eb zakonisht n\u00ebn mbik\u00ebqyrjen e qendr\u00ebs bariatrike.<\/p>\n\n\n\n
N\u00ebse endoskopisti ka p\u00ebrvoj\u00eb t\u00eb mjaftueshme dhe \u00ebsht\u00eb m\u00ebsuar me ndryshimet anatomike t\u00eb krijuara nga kirurgjia bariatrike; Endoskopia mund t\u00eb ndihmoj\u00eb n\u00eb gjetjen e fokusit t\u00eb gjakderdhjes n\u00eb pjes\u00ebn e brendshme t\u00eb linj\u00ebs kryesore dhe ta ndaloj\u00eb at\u00eb me injeksion adrenalin, elektrokoagulim ose endoklips.<\/p>\n\n\n\n
Obstruksionet e zorr\u00ebs s\u00eb vog\u00ebl pas operacioneve bariatrike: Nj\u00eb nga situatat m\u00eb t\u00eb zakonshme q\u00eb hasin kirurg\u00ebt e p\u00ebrgjithsh\u00ebm dhe mjek\u00ebt e urgjenc\u00ebs \u00ebsht\u00eb vler\u00ebsimi dhe trajtimi i obstruksioneve t\u00eb zorr\u00ebve t\u00eb vogla.Algoritmi standard i qasjes p\u00ebr obstruksionet e zorr\u00ebve t\u00eb vogla fillon me qasje jokirurgjikale si dekompresimi nazogastrik, pushimi i zorr\u00ebve, ringjallja e l\u00ebngjeve dhe monitorimi i af\u00ebrt. Shumica e pacient\u00ebve mund t\u00eb trajtohen me k\u00ebto metoda konservatore n\u00ebse nuk ka shenja t\u00eb kequshqyerjes vaskulare.<\/p>\n\n\n\n
Herniet e vendit t\u00eb trokarit jan\u00eb nj\u00eb nd\u00ebrlikim i pazakont\u00eb i kirurgjis\u00eb laparoskopike. Megjithat\u00eb, duhet t\u00eb merret parasysh se vlerat e larta t\u00eb BMI-s\u00eb krijojn\u00eb nj\u00eb faktor rreziku t\u00eb r\u00ebnd\u00ebsish\u00ebm dhe kjo mund\u00ebsi \u00ebsht\u00eb m\u00eb e lart\u00eb n\u00eb pacient\u00ebt bariatrik\u00eb. Diagnoza mund t\u00eb b\u00ebhet me gjetjet klinike, radiografi t\u00eb thjesht\u00eb t\u00eb barkut dhe ekzaminime t\u00eb sistemit t\u00eb sip\u00ebrm t\u00eb tretjes.<\/p>\n\n\n\n
Gur\u00ebt e fshik\u00ebz\u00ebs s\u00eb t\u00ebmthit dhe traktit pas kirurgjis\u00eb bariatrike: Gur\u00ebt e t\u00ebmthit zakonisht shihen n\u00eb 6 muajt e par\u00eb pas operacionit.Gur\u00ebt e t\u00ebmthit q\u00eb shfaqen me simptoma t\u00eb tilla si kolecistiti akut n\u00eb nj\u00eb pacient me nj\u00eb histori t\u00eb kirurgjis\u00eb bariatrike nuk p\u00ebrb\u00ebjn\u00eb problem p\u00ebr nj\u00eb kirurg t\u00eb p\u00ebrgjithsh\u00ebm. Diagnoza mund t\u00eb b\u00ebhet me ultratinguj, tomografi ose MR-kolangiografi. Kur zbulohet obstruksioni i kanalit t\u00eb p\u00ebrbashk\u00ebt biliar, trajtimi endoskopik ose kirurgjik varet t\u00ebr\u00ebsisht nga p\u00ebrvoja e kirurgut dhe gjendja e pacientit.<\/p>\n\n\n\n
S\u00ebmundja e refluksit gastro-ezofageal pas operacionit bariatrik: Pacient\u00ebt q\u00eb i jan\u00eb n\u00ebnshtruar operacionit bariatrik\u00eb mund t\u00eb paraqiten n\u00eb urgjenc\u00eb me dhimbje t\u00eb forta epigastrike, dhimbje djeg\u00ebse n\u00eb gjoks ose dhimbje gjoksi. Djegia e r\u00ebnd\u00eb gastroezofageale mund t\u00eb ndodh\u00eb me nj\u00eb shkall\u00eb t\u00eb lart\u00eb. Kjo gjendje \u00ebsht\u00eb shpesh p\u00ebr shkak t\u00eb s\u00ebmundjes s\u00eb refluksit q\u00eb neglizhohet para operacionit bariatrik.<\/p>\n\n\n\n
Diseksioni agresiv dhe mbyllja e defektit hiatal jan\u00eb shum\u00eb t\u00eb r\u00ebnd\u00ebsishme p\u00ebr hernin\u00eb hiatale gjat\u00eb operacionit. Simptomat e refluksit pas gastrektomis\u00eb s\u00eb m\u00ebng\u00ebs zakonisht shfaqen n\u00eb vitin e par\u00eb pas operacionit. Kulmi i dyt\u00eb i refluksit mund t\u00eb ndodh\u00eb n\u00eb nj\u00eb faz\u00eb t\u00eb m\u00ebvonshme. Ila\u00e7et frenuese t\u00eb pomp\u00ebs protonike p\u00ebrb\u00ebjn\u00eb hapin e par\u00eb t\u00eb trajtimit n\u00eb pacient\u00ebt me simptoma t\u00eb refluksit gastroezofageal t\u00eb ri, pas gastrektomis\u00eb s\u00eb m\u00ebng\u00ebs. N\u00eb nj\u00eb rast t\u00eb till\u00eb, pacienti duhet t\u00eb referohet n\u00eb nj\u00eb qend\u00ebr bariatrike sa her\u00eb q\u00eb \u00ebsht\u00eb e mundur.ALGORITMI I QASJES P\u00cbR PACIENT\u00cbT BARIATRIK N\u00cb SH\u00cbRBIMET E EMERGJENCAVE<\/p>\n\n\n\n
Afrimi i pacient\u00ebve bariatrik\u00eb n\u00eb situata urgjente mund t\u00eb paraqes\u00eb sfida t\u00eb jasht\u00ebzakonshme. Situatat q\u00eb duhen marr\u00eb parasysh jan\u00eb t\u00eb shumta dhe t\u00eb ndryshme. Prandaj, pas ringjalljes fillestare, duhet t\u00eb kryhet nj\u00eb proces diagnostikues sistematik hap pas hapi. Kjo varet nga njohja e procedur\u00ebs specifike q\u00eb i \u00ebsht\u00eb n\u00ebnshtruar pacientit. Konsultimi me nj\u00eb kirurg bariatri duhet t\u00eb merret sa m\u00eb shpejt q\u00eb t\u00eb jet\u00eb e mundur. Pacienti duhet t\u00eb transferohet n\u00eb qendr\u00ebn bariatrike sapo ta lejoj\u00eb gjendja e pacientit.<\/p>\n","protected":false},"excerpt":{"rendered":"
P\u00ebrdorimi i gjer\u00eb i kirurgjis\u00eb laparoskopike t\u00eb obezitetit ka b\u00ebr\u00eb q\u00eb mjek\u00ebt e urgjenc\u00ebs dhe kirurg\u00ebt e p\u00ebrgjithsh\u00ebm t\u00eb p\u00ebrballen me komplikime akute dhe kronike t\u00eb kirurgjis\u00eb bariatrike. Pacient\u00ebt q\u00eb i jan\u00eb n\u00ebnshtruar operacionit bariatrik\u00eb duhet t\u00eb marrin nj\u00eb qasje me faza n\u00ebse hasin ndonj\u00eb urgjenc\u00eb. P\u00ebrpjekjet p\u00ebr reanimim jan\u00eb t\u00eb nj\u00ebjta si p\u00ebr pacient\u00ebt […]<\/p>\n","protected":false},"author":1,"featured_media":28128,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[117],"tags":[],"class_list":["post-29143","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized-sq"],"_links":{"self":[{"href":"https:\/\/drburakkavlakoglu.com\/sq\/wp-json\/wp\/v2\/posts\/29143","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drburakkavlakoglu.com\/sq\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drburakkavlakoglu.com\/sq\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drburakkavlakoglu.com\/sq\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/drburakkavlakoglu.com\/sq\/wp-json\/wp\/v2\/comments?post=29143"}],"version-history":[{"count":0,"href":"https:\/\/drburakkavlakoglu.com\/sq\/wp-json\/wp\/v2\/posts\/29143\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/drburakkavlakoglu.com\/sq\/wp-json\/wp\/v2\/media\/28128"}],"wp:attachment":[{"href":"https:\/\/drburakkavlakoglu.com\/sq\/wp-json\/wp\/v2\/media?parent=29143"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drburakkavlakoglu.com\/sq\/wp-json\/wp\/v2\/categories?post=29143"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drburakkavlakoglu.com\/sq\/wp-json\/wp\/v2\/tags?post=29143"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}