Gagner Michel, Deitel Mervyn, Kalberer Traci L, Erickson Ann L, Crosby Ross D
Department of Surgery, Mount Sinai Medical Center, Miami Beach, Florida 33140, USA.
Surg Obes Relat Dis. 2009 Jul-Aug;5(4):476-85. doi: 10.1016/j.soard.2009.06.001. Epub 2009 Jun 13.
Sleeve gastrectomy (SG) is a rapid and comparatively simple bariatric operation, which thus far shows good resolution of co-morbidities and good weight loss. The potential peri-operative complications must be recognized and treated promptly. Like other bariatric operations, there are variations in technique. Laparoscopic SG was initially performed for high-risk patients to increase the safety of a second operation. However, indications for SG have been increasing. Interaction among those performing this procedure is necessary, and the Second International Consensus Summit for SG (ICSSG) was held to evaluate techniques and results.
A questionnaire was filled out by attendees at the Second ICSSG, held March 19-22, 2009, in Miami Beach, and rapid responses were recorded during the consensus part.
Findings are based on 106 questionnaires representing a total of 14,776 SGs. In 86.3%, SG was intended as the sole operation. A total of 81.9% of the surgeons reported no conversions from a laparoscopic to an open SG. Mean +/- SD percent excess weight loss was as follows: 1 year, 60.7 +/- 15.6; 2 years, 64.7 +/- 12.9; 3 years, 61.7 +/- 11.4; 4 years 64.6 +/- 10.5; >4 years, 48.5 +/- 8.7. Bougie size was 35.6F +/- 4.9F (median 34.0F, range 16F-60F). The dissection commenced 5.0 +/- 1.4 cm (median 5.0 cm, range 1-10 cm) proximal to the pylorus. Staple-line was reinforced by 65.1% of the responders; of these, 50.9% over-sew, 42.1% buttress, and 7% do both. Estimated percent of fundus removed was 95.8 +/- 12%; many expressed caution to avoid involving the esophagus. Post-operatively, a high leak occurred in 1.5%, a lower leak in 0.5%, hemorrhage in 1.1%, splenic injury in 0.1%, and later stenosis in 0.9%. Post-operative gastroesophageal reflux ( approximately 3 mo) was reported in 6.5% (range 0-83%). Mortality was 0.2 +/- 0.9% (total 30 deaths in 14,776 patients). During the consensus part, the audience responded that there was enough evidence published to support the use of SG as a primary procedure to treat morbid obesity and indicated that it is on par with adjustable gastric banding and Roux-en-Y gastric bypass, with a yes vote at 77%.
SG for morbid obesity is very promising as a primary operation.
袖状胃切除术（SG）是一种快速且相对简单的减肥手术，迄今为止，该手术在解决合并症和减轻体重方面效果良好。必须及时识别并治疗潜在的围手术期并发症。与其他减肥手术一样，该手术在技术上存在差异。腹腔镜袖状胃切除术最初是为高危患者实施的，以提高二次手术的安全性。然而，袖状胃切除术的适应症一直在增加。实施该手术的人员之间进行交流很有必要，因此召开了第二届袖状胃切除术国际共识峰会（ICSSG）来评估技术和手术结果。
参加2009年3月19日至22日在迈阿密海滩举行的第二届ICSSG的与会者填写了一份问卷，并在共识环节记录了快速反馈。
研究结果基于106份问卷，这些问卷代表了总共14776例袖状胃切除术。在86.3%的病例中，袖状胃切除术被作为唯一的手术方式。共有81.9%的外科医生报告没有将腹腔镜袖状胃切除术转为开放手术。平均±标准差的超重减轻百分比如下：1年，60.7±15.6；2年，64.7±12.9；3年，61.7±11.4；4年，64.6±10.5；超过4年，48.5±8.7。探条尺寸为35.6F±4.9F（中位数34.0F，范围16F - 60F）。解剖在距幽门近端5.0±1.4厘米（中位数5.0厘米，范围1 - 10厘米）处开始。65.1%的受访者对吻合线进行了加固；其中，50.9%进行了缝合，42.1%使用了支撑物，7%两者都用。估计切除的胃底百分比为95.8±12%；许多人表示要谨慎操作以避免累及食管。术后，高漏发生率为1.5%，低漏发生率为0.5%，出血发生率为1.1%，脾损伤发生率为0.1%，后期狭窄发生率为0.9%。术后胃食管反流（约3个月）的报告发生率为6.5%（范围0 - 83%）。死亡率为0.2±0.9%（14776例患者中共有30例死亡）。在共识环节，与会者表示有足够的已发表证据支持将袖状胃切除术作为治疗病态肥胖的主要手术方式，并指出它与可调节胃束带术和Roux - en - Y胃旁路术相当，赞成票占77%。
袖状胃切除术作为治疗病态肥胖的主要手术很有前景。
