Goitein David, Goitein Orly, Feigin Anya, Zippel Douglas, Papa Moshe
Department of Surgery C, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Surg Endosc. 2009 Jul;23(7):1559-63. doi: 10.1007/s00464-009-0337-2. Epub 2009 Feb 27.
Laparoscopic sleeve gastrectomy (LSG) is gaining popularity as an additional bariatric procedure, either as a first step for biliopancreatic diversion or gastric bypass or as a stand-alone option for selected patients. Early postoperative fluid tolerance varies between patients and influences the length of hospital stay. Swallow studies after LSG are not uniform and display different patterns with regard to contrast passage through the gastric sleeve.
The 55 patients (40 women) in this study underwent LSG during 18 months. These patients had a mean age of 38.2 years (range: 17-61 years) and a mean body mass index (BMI) of 44.8 kg/m(2) (range: 39-75 kg/m(2)). The LSG procedure was performed using a four-port technique to resect the greater curvature of the stomach around a bougie. The mean operative time was 120 min (range: 45-240 min). A routine swallow study was performed on postoperative day 1, and clear fluids were initiated if no leak was detected. Patients were discharged when they could tolerate a daily fluid intake of 2 l.
No mortalities, obstructions, or leaks occurred in the study cohort. Two main patterns of contrast passage were identified: type 1 (immediate unhindered flow through the sleeve to the antrum with a slight delay before continuation of the contrast to the duodenum) and type 2 (contrast filling of the proximal sleeve with delay of flow distally toward the duodenum). Patients with rapid contrast passage (group 1, n = 24) tolerated clear fluids better than those with delayed flow (group 2, n = 31) and were discharged earlier than their counterparts (mean length of hospital stay, 2.5 vs. 3.4 days; p < 0.001).
Tolerance of fluid intake after LSG is crucial for patient recovery and discharge. A distinct radiologic appearance on postoperative day 1 helps to predict this behavior. The different patterns could be related to gastric sleeve construction or to possible postoperative sleeve spasm, hindering fluid passage. The influence of immediate fluid tolerance on weight loss after LSG is currently under investigation.
腹腔镜袖状胃切除术（LSG）作为一种额外的减肥手术正越来越受欢迎，它既可以作为胆胰转流术或胃旁路手术的第一步，也可以作为特定患者的独立选择。术后早期患者对液体的耐受性各不相同，这会影响住院时间。LSG术后的吞咽研究并不统一，在造影剂通过胃袖套方面呈现出不同的模式。
本研究中的55例患者（40例女性）在18个月内接受了LSG手术。这些患者的平均年龄为38.2岁（范围：17 - 61岁），平均体重指数（BMI）为44.8kg/m²（范围：39 - 75kg/m²）。LSG手术采用四孔技术，围绕探条切除胃大弯。平均手术时间为120分钟（范围：45 - 240分钟）。术后第1天进行常规吞咽研究，如果未检测到渗漏，则开始给予清流食。患者能够耐受每日2升液体摄入时即可出院。
研究队列中未发生死亡、梗阻或渗漏情况。确定了两种主要的造影剂通过模式：1型（造影剂立即无阻碍地通过袖套进入胃窦，在继续进入十二指肠前稍有延迟）和2型（近端袖套造影剂充盈，向十二指肠远端的流动延迟）。造影剂通过迅速的患者（第1组，n = 24）比流动延迟的患者（第2组，n = 31）对清流食的耐受性更好，且出院时间更早（平均住院时间，2.5天对3.4天；p < 0.001）。
LSG术后对液体摄入的耐受性对患者康复和出院至关重要。术后第1天独特的放射学表现有助于预测这种情况。不同模式可能与胃袖套结构或术后可能的袖套痉挛有关，从而阻碍液体通过。目前正在研究LSG术后即刻液体耐受性对体重减轻的影响。
