Lee Crystine M, Cirangle Paul T, Jossart Gregg H
Department of Surgery, California Pacific Medical Center, San Francisco, CA, USA.
Surg Endosc. 2007 Oct;21(10):1810-6. doi: 10.1007/s00464-007-9276-y. Epub 2007 Mar 14.
The vertical gastrectomy (VG) is the restrictive part of the technically difficult biliopancreatic diversion with duodenal switch operation (DS). The VG was originally conceived of as an independent operation-the first stage of a two-stage DS that would reduce mortality and morbidity in the high-risk superobese because of a shorter operating time and no anastomoses. This article presents two-year data after VG.
Laparoscopic VG was performed in a nonrandomized fashion in obese patients that met the NIH criteria for bariatric surgery. By using 5-7 firings of 45-60-mm linear 3.5-mm GI staplers along a 32-Fr bougie, a greater-curvature gastrectomy is performed and a 60-80-ml gastric tube is created. VG was compared to adjustable Lap-Band placement, Roux-en-Y gastric bypass (RGB), and DS.
Between November 2002 and August 2005, 216 patients underwent VG. The mean age was 44.7 years (range = 16-64) and 173 (80%) were female. The mean preoperative weight and body mass index (BMI) was 302 +/- 77 lbs and 49 +/- 11 kg/m2, respectively. Of the 216 patients, 5 (2.3%) had a BMI > 80 kg/m2, 6 (2.8%) had a BMI of 70-80 kg/m(2), and 25 (11.6%) had a BMI of 60-70 kg/m2. The mean operative time was 66 +/- 11 min (range = 45-180) and the mean length of hospital stay was 1.9 +/- 1.2 days. Complications occurred in 20 (6.3%) patients (vs. 7.1% after Lap-Band). Leaks occurred in 3 (1.4%) VG patients, reoperations were performed in 6 (2.8%), and no conversions to open or deaths occurred. Weight loss on par with the DS and RGB was achieved with just the VG alone.
The VG operation is able to achieve significant weight loss comparable to the RGB and DS operations but with the low morbidity profile similar to that of Lap-Band placement.
垂直胃切除术（VG）是技术难度较大的胆胰转流十二指肠转位术（DS）中的限制性部分。VG最初被设想为一种独立手术——两阶段DS的第一阶段，由于手术时间较短且无吻合口，该手术可降低高危超级肥胖患者的死亡率和发病率。本文介绍了实施VG术后两年的数据。
对符合美国国立卫生研究院（NIH）减肥手术标准的肥胖患者以非随机方式实施腹腔镜VG。沿着32F探条使用45 - 60毫米线性3.5毫米胃肠吻合器进行5 - 7次击发，实施大弯侧胃切除术并制作一个60 - 80毫升的胃管。将VG与可调节胃束带置入术、Roux - en - Y胃旁路术（RGB）和DS进行比较。
2002年11月至2005年8月期间，216例患者接受了VG手术。平均年龄为44.7岁（范围 = 16 - 64岁），173例（80%）为女性。术前平均体重和体重指数（BMI）分别为302±77磅和49±11千克/平方米。在216例患者中，5例（2.3%）BMI＞80千克/平方米，6例（2.8%）BMI为70 - 80千克/平方米，25例（11.6%）BMI为60 - 70千克/平方米。平均手术时间为66±11分钟（范围 = 45 - 180分钟），平均住院时间为1.9±1.2天。20例（6.3%）患者发生并发症（与胃束带置入术后的7.1%相比）。3例（1.4%）VG患者发生渗漏，6例（2.8%）进行了再次手术，未发生转为开放手术或死亡情况。仅通过VG手术就实现了与DS和RGB相当的体重减轻。
VG手术能够实现与RGB和DS手术相当的显著体重减轻，但发病率较低，与胃束带置入术相似。
