Madan Atul K, Lanier Brock, Tichansky David S
Section of Minimally Invasive Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
Am Surg. 2006 Jul;72(7):586-90; discussion 590-1.
Gastrointestinal (GI) leak after gastric bypass is a cause of significant morbidity and a mortality that may exceed 50%. This study was performed to review our experience with laparoscopic repair of GI leaks after laparoscopic Roux-en-Y gastric bypass (LRYGB). A retrospective chart review of all patients who underwent LRYGB over a 25-month period was performed. Patients who had any operation for a GI leak after LRYGB were included in this study. There were 300 patients who underwent LRYGB. No intraoperative conversions occurred. Eight (2.7%) patients underwent operative repair of a GI leak. Another patient had a gastrojejunostomy leak that was managed nonoperatively. The rate of GI leaks reduced from 5.3 per cent in the first 150 cases to 0.7 per cent in the last 150 cases (P < 0.05). One patient was converted to an open approach. Average operative time for the laparoscopic repairs was 133 minutes (range, 75-182 minutes). Sources of leak found at operation were gastrojejunostomy (3), enterotomy (3), jejunojejunostomy (2), gastric pouch (1), and cystic duct stump (1). Two patients had a GI leak from two sources. Average length of stay was 28 days (range, 4-78 days). Three patients whose stay was greater than a month were the result of sepsis and ventilator dependence. Further reoperations were required in two patients (laparoscopic) for abdominal washout and one patient (open) for enterotomy repair. One patient required computed tomography-guided drainage of an abscess. Mortality was 22 per cent (2) in patients who developed GI leaks. One patient died from sepsis-induced multiple organ failure and the other patient from a presumed pulmonary embolus. GI leaks cause significant morbidity and mortality. GI leak rates decrease with experience. Laparoscopic repair of GI leaks should be used judiciously. Conversions and further reoperations may be necessary.
胃旁路术后胃肠道（GI）漏是导致严重发病和死亡的原因，死亡率可能超过50%。本研究旨在回顾我们在腹腔镜Roux-en-Y胃旁路术（LRYGB）后腹腔镜修复GI漏的经验。对在25个月期间接受LRYGB的所有患者进行了回顾性病历审查。LRYGB术后因GI漏而接受任何手术的患者纳入本研究。共有300例患者接受了LRYGB。术中无中转开腹情况。8例（2.7%）患者接受了GI漏的手术修复。另有1例患者发生胃空肠吻合口漏，采用非手术治疗。GI漏发生率从前150例中的5.3%降至后150例中的0.7%（P<0.05）。1例患者中转开腹。腹腔镜修复的平均手术时间为133分钟（范围75 - 182分钟）。术中发现的漏口来源为胃空肠吻合口（3例）、肠切开处（3例）、空肠空肠吻合口（2例）、胃囊（1例）和胆囊管残端（1例）。2例患者有两个部位发生GI漏。平均住院时间为28天（范围4 - 78天）。3例住院时间超过1个月的患者是由于脓毒症和依赖呼吸机。2例患者（腹腔镜手术）需要进一步手术进行腹腔冲洗，1例患者（开腹手术）需要进行肠切开修复。1例患者需要计算机断层扫描引导下引流脓肿。发生GI漏的患者死亡率为22%（2例）。1例患者死于脓毒症诱发的多器官功能衰竭，另1例患者推测死于肺栓塞。GI漏会导致严重的发病和死亡。GI漏发生率会随着经验的增加而降低。腹腔镜修复GI漏应谨慎使用。可能需要中转开腹和进一步的再次手术。
