Till H, Blüher S, Hirsch W, Kiess W
Department of Pediatric Surgery, University Hospital of Leipzig, Leipzig, Germany.
Obes Surg. 2008 Aug;18(8):1047-9. doi: 10.1007/s11695-008-9543-6. Epub 2008 May 6.
Laparoscopic sleeve gastrectomy (LSG) is basically unknown as a stand-alone technique for bariatric surgery in children and adolescents. It may be advantageous for this age group though, since it requires neither foreign body placement nor life-long malabsorption. We present the first report about the efficacy of LSG in a small pediatric series.
All patients (n = 4, female) had been in a multi-modal weight loss program for several years without long-term success. At referral, the mean age was 14.5 years (range 8-17), mean body mass index (BMI in kg/m(2)) was 48.4 (range 40.6-56.3). All suffered from various features of a metabolic-vascular syndrome like diabetes, dislipidemia, cholecystolithiasis, arterial hypertension. The 8-year-old girl was diagnosed Prader-Willi Syndrome at the age of 2. The decision for bariatric surgery was taken unanimously by the parents, patient, and the obesity team. LSG was performed in a five-trocar technique. With a gastroscope (size 40-F) protecting the lesser curvature, the stomach was resected from the proximal antrum to the angle of His using an ENDO-GIA stapler. The stapler line was secured by a continuous suture 3-0 vicryl.
There were no intra- or postoperative complications. Contrast studies confirmed a J-like gastric remnant (mean volume 76 ml) and ruled out leaks in all cases. After a mean follow-up time of 12 months (range 6-19 months), all the patients had reduced weight (mean BMI to 37.2). The girl with the longest postoperative period went from 121 to 83 kg (BMI from 40.6 to 28.4). Laboratory studies ruled out malnutrition or vitamin deficiency. Monitoring of metabolic parameters showed gradual improvement or even resolution for most features.
At a 1-year follow-up, LSG proved a safe and effective option for bariatric surgery in children, achieving moderate weight loss and improvement of comorbidities. Thus, it may be considered as stand-alone technique. Long-term studies however must compare these results with time-tested procedures like gastric banding and Roux-en-Y gastric bypass.
腹腔镜袖状胃切除术（LSG）作为一种独立的儿童及青少年减肥手术技术基本不为人知。不过，对于这个年龄组而言它可能具有优势，因为它既不需要植入异物，也不会导致终身吸收不良。我们报告了关于LSG在一小批儿科患者中的疗效的首例报告。
所有患者（n = 4，均为女性）都参加了多年的多模式减肥项目，但未取得长期成功。转诊时，平均年龄为14.5岁（范围8 - 17岁），平均体重指数（BMI，单位为kg/m²）为48.4（范围40.6 - 56.3）。所有患者都患有代谢 - 血管综合征的各种特征，如糖尿病、血脂异常、胆囊结石、动脉高血压。这位8岁女孩在2岁时被诊断为普拉德 - 威利综合征。减肥手术的决定由父母、患者和肥胖症治疗团队一致做出。LSG采用五孔技术进行。使用胃镜（40 - F型号）保护胃小弯，使用内镜切割吻合器从胃近端 antrum 至His角切除胃。吻合器缝线用3 - 0可吸收缝线连续缝合加固。
术中及术后均无并发症。造影检查证实胃残余呈J形（平均容积76 ml），且所有病例均排除渗漏。平均随访12个月（范围6 - 19个月）后，所有患者体重均减轻（平均BMI降至37.2）。术后时间最长的女孩体重从121 kg降至83 kg（BMI从40.6降至28.4）。实验室检查排除了营养不良或维生素缺乏。代谢参数监测显示大多数特征逐渐改善甚至消失。
在1年的随访中，LSG被证明是儿童减肥手术的一种安全有效的选择，能实现适度体重减轻并改善合并症。因此，它可被视为一种独立的技术。然而，长期研究必须将这些结果与诸如胃束带术和 Roux - en - Y 胃旁路术等经过时间考验的手术进行比较。
