Givon-Madhala Osnat, Spector Rona, Wasserberg Nir, Beglaibter Nahum, Lustigman Hagit, Stein Michael, Arar Nazik, Rubin Moshe
Department of Surgery B, Felsenstein Research Center Rabin Medical Center, Petah Tiqva, Israel.
Obes Surg. 2007 Jun;17(6):722-7. doi: 10.1007/s11695-007-9133-z.
Laparoscopic sleeve gastrectomy (LSG) has recently come to be performed as a sole bariatric operation. The postoperative morbidity and mortality are cause for concern, and possibly are related to non-standardized surgical technique.
The following is the surgical LSG technique used in 25 morbidly obese patients. Five trocars are used. Division of the vascular supply of the greater gastric curvature is begun at 6-7 cm proximal to the pylorus, proceeding to the angle of His. A 50-Fr calibrating bougie is positioned against the lesser curvature. The LSG is created using a linear stapler-cutter device with one 4.1-mm green load for the antrum, followed by five to seven sequential 3.5-mm blue loads for the remaining gastric corpus and fundus. The staple-line is inverted by placing a sero-serosal continuous absorbable suture over the bougie from the angle of His. The resected stomach is removed through the 12-mm trocar, and a Jackson-Pratt drain is left along the suture-line.
The mean operative time was 120 minutes, and length of hospital stay was 4 +/- 2 days. There were no conversions to open procedures. There were no postoperative complications (no hemorrhage from the staple-line, no anastomotic leakage, no stricture) and no mortality. In 1 patient, cholecystectomy was also done, and in 4, a gastric band was removed. During a median follow-up of 4 months, BMI decreased from 43 +/- 5 kg/m2 to 34 +/- 6 kg/m2, and the % excess BMI loss was 49 +/- 25%.
The proposed surgical technique appears to be a safe and effective procedure for morbid obesity.
腹腔镜袖状胃切除术（LSG）近来已作为一种单独的减肥手术开展。术后发病率和死亡率令人担忧，可能与手术技术不规范有关。
以下是用于25例病态肥胖患者的LSG手术技术。使用5个套管针。在距幽门近端6 - 7 cm处开始离断大胃弯的血管供应，直至His角。将一根50 Fr的校准探条靠在小弯侧。使用线性切割吻合器创建LSG，胃窦部用一个4.1 mm的绿色钉仓，随后胃体和胃底部用五到七个连续的3.5 mm蓝色钉仓。通过从His角开始在探条上放置连续可吸收的浆膜 - 浆膜缝线使钉合线内翻。切除的胃通过12 mm的套管针取出，并在缝合线处留置一根Jackson - Pratt引流管。
平均手术时间为120分钟，住院时间为4±2天。无转为开放手术的情况。无术后并发症（钉合线无出血、无吻合口漏、无狭窄）且无死亡病例。1例患者同时进行了胆囊切除术，4例患者取出了胃束带。在中位随访4个月期间，体重指数从43±5 kg/m²降至34±6 kg/m²，超重体重指数丢失百分比为49±25%。
所提出的手术技术对于病态肥胖似乎是一种安全有效的手术方法。
