在猪模型中使用聚四氟乙烯包裹进行袖状胃切除术以防止胃扩张。

Sleeve gastrectomy with wrapping using polytetrafluoroethylene to prevent gastric enlargement in a porcine model.

作者信息

Ueda Kazuki, Gagner Michel, Milone Luca, Bardaro Sergio J, Gong Ke

机构信息

Department of Surgery, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, New York, USA.

出版信息

Surg Obes Relat Dis. 2008 Mar-Apr;4(2):84-90. doi: 10.1016/j.soard.2006.12.007. Epub 2007 Apr 2.

DOI:10.1016/j.soard.2006.12.007

PMID:17400032

Abstract

BACKGROUND

The safety and efficacy of laparoscopic sleeve gastrectomy followed by biliopancreatic diversion with duodenal switch for morbid obesity has been well established. We previously recommended 2-stage laparoscopic biliopancreatic diversion with duodenal switch for super-super obese patients. In the 2-stage version, these patients undergo laparoscopic sleeve gastrectomy as a first-stage procedure, followed by laparoscopic biliopancreatic diversion with duodenal switch as the second stage for more definitive treatment of their obesity. However, short-term weight regain may occur owing to gastric dilation after initial laparoscopic sleeve gastrectomy. The aim of this study was to prevent gastric dilation after sleeve gastrectomy. We designed a sleeve gastrectomy with wrapping using polytetrafluoroethylene dual mesh.

METHODS

Eleven Yorkshire pigs weighing 20-25 kg underwent sleeve gastrectomy with wrapping using polytetrafluoroethylene dual mesh (wrapping group) or sleeve gastrectomy only (control group) to compare the weight loss. The animals were weighed weekly postoperatively. Necropsy was performed 8 weeks postoperatively to confirm the wrapping by pathologic report.

RESULTS

Four pigs died because of staple line failure or strangulation; no perioperative complications occurred in the other pigs. The operative time for the control group was 198 +/- 60 minutes and for the wrapping group was 181 +/- 86 minutes (P = NS). The average weight of the removed stomach was 123.3 +/- 5.8 g in the control group and 140.3 +/- 69.9 g in the wrapping group (P = NS). The postoperative weight gain at 8 weeks was significantly slower in the wrapping group than in the control group (P <.0001). The pathologic necropsy report noted that the mesh was well attached to the stomach wall at 9 days postoperatively, with no unexpected deaths.

CONCLUSION

Sleeve gastrectomy with wrapping using polytetrafluoroethylene dual mesh is feasible, and weight gain was reduced in the porcine model.

摘要

背景

腹腔镜袖状胃切除术联合胆胰转流十二指肠转位术治疗病态肥胖的安全性和有效性已得到充分证实。我们之前推荐对超级肥胖患者采用两阶段腹腔镜胆胰转流十二指肠转位术。在两阶段术式中，这些患者首先接受腹腔镜袖状胃切除术作为第一阶段手术，随后进行腹腔镜胆胰转流十二指肠转位术作为第二阶段手术，以更彻底地治疗肥胖症。然而，初次腹腔镜袖状胃切除术后可能因胃扩张导致短期体重反弹。本研究的目的是预防袖状胃切除术后的胃扩张。我们设计了一种使用聚四氟乙烯双层网片包裹的袖状胃切除术。

方法

11只体重20 - 25千克的约克夏猪接受了使用聚四氟乙烯双层网片包裹的袖状胃切除术（包裹组）或仅接受袖状胃切除术（对照组），以比较体重减轻情况。术后每周对动物进行称重。术后8周进行尸检，通过病理报告确认包裹情况。

结果

4只猪因吻合口漏或绞窄死亡；其他猪未发生围手术期并发症。对照组的手术时间为198±60分钟，包裹组为181±86分钟（P =无显著差异）。对照组切除胃的平均重量为123.3±5.8克，包裹组为140.3±69.9克（P =无显著差异）。包裹组术后8周的体重增加明显慢于对照组（P <.0001）。病理尸检报告指出，术后9天网片与胃壁附着良好，无意外死亡情况。