Department of Surgery, University of Chile Clinical Hospital, Santos Dumont 999, Santiago, Chile.
J Gastrointest Surg. 2010 Sep;14(9):1343-8. doi: 10.1007/s11605-010-1249-0. Epub 2010 Jun 22.
Laparoscopic sleeve gastrectomy (LSG) is a surgical procedure that is being increasingly performed on obese patients. The most frequent postoperative complication is the appearance of a gastric leak.
To determine the main clinical features of a group of patients who developed a gastric leak after LSG.
A total of 343 obese patients were submitted to LSG, two hundred and sixty-two women and 81 men with a mean age of 37.3 years and a BMI of 37.5 kg/m(2). Radiological evaluations were performed on all patients on the third day after surgery using liquid sulfate barium, as well as a close clinical control evaluation to monitor the appearance of epigastric pain, fever, tachycardia, C-reactive protein, and leukocytosis. Medical or surgical management of the leak were employed.
Fever was the earliest and most frequent symptom, followed by epigastric pain and tachycardia. Leaks were classified based on three parameters: severity or magnitude, location, and time of appearance after surgery. Leaks were classified as early if they appeared 1 to 4 days after surgery, intermediate if they appeared 5 to 9 days after surgery, and late 10 days after surgery. The diagnosis of a leak was confirmed with a barium liquid taken orally by six patients and with an abdominal CAT scan in ten. Surgical management was performed in eight patients, usually in those with early leaks (six patients). Early re-suturing in three patients was successful; however, re-suturing leaks after the third day resulted in failure. Medical management was performed mainly in patients with intermediate and late leaks, mainly through enteral nutrition and percutaneous drainage of the intra-abdominal fluid collection. There was no mortality. The mean healing days of these leaks was 45 days after surgery.
Close clinical observation detects gastric leaks early on inpatients who underwent LSG. We suggest evaluating these leaks based on three parameters: time of appearance, the location, and its severity, in order to propose the best medical or surgical treatment in these patients.
腹腔镜袖状胃切除术（LSG）是一种在肥胖患者中越来越常见的手术。最常见的术后并发症是胃漏的出现。
确定一组接受 LSG 后发生胃漏的患者的主要临床特征。
共有 343 名肥胖患者接受了 LSG，其中 262 名女性和 81 名男性，平均年龄 37.3 岁，BMI 为 37.5kg/m²。所有患者均在术后第三天进行了硫酸钡液体的放射学评估，并进行了密切的临床对照评估，以监测上腹痛、发热、心动过速、C 反应蛋白和白细胞增多的出现。采用药物或手术方法对漏液进行处理。
发热是最早和最常见的症状，其次是上腹痛和心动过速。漏液根据三个参数进行分类：严重程度或大小、位置和手术后出现的时间。如果在手术后 1-4 天出现漏液，则将其分类为早期；如果在手术后 5-9 天出现漏液，则将其分类为中期；如果在手术后 10 天出现漏液，则将其分类为晚期。六名患者经口服钡剂液体确诊漏液，十名患者经腹部 CAT 扫描确诊。八名患者接受了手术治疗，通常是在那些早期漏液患者（六名患者）中。三名患者的早期再缝合成功，但第三天以后的再缝合漏液则失败。主要对中期和晚期漏液患者进行药物治疗，主要通过肠内营养和经皮引流腹腔内积液。无死亡病例。这些漏液的平均愈合时间为手术后 45 天。
密切的临床观察可以早期发现接受 LSG 的住院患者的胃漏。我们建议根据出现时间、位置和严重程度这三个参数来评估这些漏液，以便为这些患者提供最佳的药物或手术治疗。
