Peptik Ülser Hastalığı ve Cerrahi Tedavisi
Özet
Peptik ülser hastalığı, asit baskılayıcı güçlü medikal ajanların geliştirilmesi ve Helikobakter pilori (H. pilori) enfeksiyonu tedavisinin başarısı sayesinde son otuz yılda elektif cerrahi müdahale gereksinimini neredeyse tamamen ortadan kaldırmıştır. Günümüzde peptik ülser cerrahisi, büyük oranda kanama, delinme (perforasyon) ve mide çıkış tıkanıklığı (obstrüksiyon) gibi hayatı tehdit eden akut komplikasyonların yönetimi ile medikal tedaviye dirençli nadir olgularla sınırlıdır. Dirençli vakalarda vagal uyarıyı kesmeye yönelik trunkal, selektif veya yüksek selektif vagotomi yöntemleri ile asit sekresyonunu azaltan antrektomi prosedürleri uygulanabilmektedir. Kanama komplikasyonlarında endoskopik tedavinin yetersiz kaldığı durumlarda duodenotomi ve ülser sütürasyonu tercih edilirken, perforasyonlarda primer onarım ve Graham yama yöntemi hem açık hem de laparoskopik cerrahiyle başarıyla gerçekleştirilmektedir. Mide çıkış obstrüksiyonlarında ise öncelikle malignite dışlanarak endoskopik balon dilatasyonu ve H. pilori eradikasyonu planlanmakta; refrakter olgularda cerrahi rezeksiyona başvurulmaktadır. Sonuç olarak, peptik ülser yönetiminde cerrahi, primer bir tedavi seçeneği olmaktan çıkıp, komplikasyon odaklı acil ve seçici bir disipline dönüşmüştür.
Peptik ulcer disease has witnessed a dramatic decline in elective surgical interventions over the past three decades due to the development of potent acid-suppressive agents and effective Helicobacter pylori (H. pylori) eradication therapies. Today, surgical management is strictly reserved for rare medically refractory cases and life-threatening complications such as bleeding, perforation, and gastric outlet obstruction. For refractory disease, acid-reducing procedures including truncal, selective, or highly selective vagotomy, often combined with antrectomy, are utilized to decrease vagal stimulation and gastrin secretion. When endoscopic interventions fail to control ulcer hemorrhage, duodenotomy accompanied by direct vessel ligation is performed. Perforations are commonly managed via primary closure reinforced with a Graham omental patch, utilizing either open laparotomy or minimally invasive laparoscopic approaches. Gastric outlet obstruction, once malignancy is ruled out, is primarily treated with endoscopic balloon dilatation and concurrent H. pylori eradication, leaving surgical resection as a final resort for recurrent scenarios. Consequently, modern ulcer surgery has transitioned from a definitive primary cure to a specialized, complication-driven emergency management strategy.
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