Department of Surgery, University of Texas Health Sciences Center at San Antonio, Mail Code 7842, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA.
Surg Endosc. 2012 Mar;26(3):738-46. doi: 10.1007/s00464-011-1945-1. Epub 2011 Nov 2.
This study aimed to determine the incidence, etiology, and management options for symptomatic stenosis (SS) after laparoscopic sleeve gastrectomy (LSG).
A retrospective study reviewed morbidly obese patients who underwent LSG between October 2008 and December 2010 to identify patients treated for SS.
In this study, 230 patients (83% female) with a mean age of 49.5 years and a mean body mass index (BMI) of 43 kg/m(2) underwent LSG. In 3.5% of these patients (100% female; mean age, 42 years; mean BMI, 42.6 kg/m(2)), SS developed. The LSG procedure was performed using a 36-Fr. bougie and tissue-reinforced staplers. Four patients had segmental staple-line imbrication, and seven patients underwent contrast study, with 71.4% demonstrating a fixed narrowing. Endoscopy confirmed short-segment stenoses: seven located at mid-body and one located near the gastroesophageal junction. Endoscopic management was 100% successful. The mean number of dilations was 1.6, and the median balloon size was 15 mm. The mean time from surgery to initial endoscopic intervention was 48.8 days, and the mean time from the first dilation to toleration of a solid diet was 49.6 days. Two patients were referred to our institution after undergoing LSG at another facility. The mean time to the transfer was 28.5 days. The two patients had a mean age of 35 years and a mean BMI of 42.3 kg/m(2). Both patients experienced immediate SS after perioperative complications comprising one staple-line hematoma and one leak. Contrast studies demonstrated minimal passage of contrast through a long-segment stenosis. Both patients underwent multiple endoscopic dilation procedures and endoluminal stenting, ultimately requiring laparoscopic conversion to Roux-en-Y gastric bypass. The mean time from the initial surgery to the surgical revision was 77 days, and the mean time after the first intervention to tolerance of a solid diet was 82 days.
Symptomatic short-segment stenoses after LSG may be treated successfully with endoscopic balloon dilation. Long-segment stenoses that do not respond to endoscopic techniques may ultimately require conversion to Roux-en-Y gastric bypass.
本研究旨在确定腹腔镜袖状胃切除术（LSG）后症状性狭窄（SS）的发生率、病因和治疗选择。
回顾性研究分析了 2008 年 10 月至 2010 年 12 月期间接受 LSG 的病态肥胖患者，以确定接受 SS 治疗的患者。
本研究中，230 例（83%为女性）患者接受 LSG，平均年龄为 49.5 岁，平均体重指数（BMI）为 43kg/m²。其中 3.5%（100%为女性；平均年龄为 42 岁；平均 BMI 为 42.6kg/m²）的患者发生 SS。LSG 手术采用 36-Fr. 扩张器和组织强化吻合器进行。4 例患者行节段性吻合线重叠术，7 例行对比研究，71.4%显示固定狭窄。内镜证实为短节段狭窄：7 例位于中体部，1 例位于胃食管交界处附近。内镜治疗 100%成功。扩张次数中位数为 1.6 次，球囊大小中位数为 15mm。从手术到初次内镜干预的平均时间为 48.8 天，从第一次扩张到耐受固体饮食的平均时间为 49.6 天。2 例患者在另一家医疗机构接受 LSG 后转诊至我院。转院的平均时间为 28.5 天。这 2 例患者的平均年龄为 35 岁，平均 BMI 为 42.3kg/m²。2 例患者均在围手术期并发症后立即出现 SS，包括 1 例吻合线血肿和 1 例漏诊。对比研究显示，长段狭窄处造影剂仅轻微通过。2 例患者均接受多次内镜扩张和内镜支架置入，最终均需腹腔镜转换为 Roux-en-Y 胃旁路术。从初始手术到手术修正的平均时间为 77 天，从初次干预到耐受固体饮食的平均时间为 82 天。
LSG 后出现的症状性短节段狭窄可通过内镜球囊扩张成功治疗。对内镜技术无反应的长段狭窄最终可能需要转换为 Roux-en-Y 胃旁路术。
