Department of Surgery, University Medical Center at Princeton, Princeton, New Jersey 08844, USA.
Surg Obes Relat Dis. 2013 Mar-Apr;9(2):229-33. doi: 10.1016/j.soard.2012.01.006. Epub 2012 Jan 16.
During the past decade, nonoperative treatment of leaks after bariatric surgery has been deemed acceptable in selected patients. The setting of our study was 2 university affiliated hospitals.
We reviewed gastric leaks in 1069 consecutive bariatric operations that were performed by 1 surgeon during the past 8 years, including 836 primary laparoscopic Roux-en-Y gastric bypass (RYGB), 114 primary open RYGBs, and 119 revisional procedures. Drains were used routinely in the laparoscopic and revision groups and selectively in the open group. Perforations and jejunojejunostomy leaks were excluded.
There were no leaks after open RYGB, 8 leaks (.95%) after laparoscopic RYGB, and 5 leaks (4.2%) after the revisional procedures. Of the 13 leaks, 7 occurred at the gastrojejunostomy, 6 at the staple line of the upper pouch, and none in the excluded stomach. Of the 8 postlaparoscopic RYGB leaks, 3 required reoperation versus 2 of 5 postrevision leaks. There were no perioperative deaths. All but 2 patients in the nonoperative group were treated with endoscopic injection of fibrin sealant (EIFS). Of the 4 leaks in the laparoscopic RYGB group, 2 treated by EIFS closed after 1 treatment; however, all leaks in the revision group required >1 EIFS treatment. The mean length of stay was 36 ± 34 days in the operative group and 33 ± 7 days in the EIFS patients. Operation for failure of EIFS was not required in any patient.
EIFS provides safe and successful treatment of patients who develop gastric leaks after bariatric operations. We recommend EIFS for all patients with endoscopically accessible leaks who can safely be treated nonoperatively.
在过去的十年中，在选定的患者中，已经认为手术后胃漏的非手术治疗是可以接受的。我们的研究环境是 2 所大学附属医院。
我们回顾了过去 8 年内由 1 位外科医生进行的 1069 例连续减重手术中的胃漏，包括 836 例原发性腹腔镜 Roux-en-Y 胃旁路术（RYGB）、114 例原发性开放 RYGB 和 119 例修正手术。腹腔镜和修正组常规使用引流管，开放组选择性使用。排除穿孔和空肠空肠吻合口漏。
开放 RYGB 后无漏，腹腔镜 RYGB 后有 8 例漏（0.95%），修正手术后有 5 例漏（4.2%）。在 13 例漏中，7 例发生在胃空肠吻合口，6 例发生在上部胃袋吻合口，排除的胃中无一例。在 8 例腹腔镜 RYGB 术后漏中，有 3 例需要再次手术，而 5 例修正术后漏中有 2 例。无围手术期死亡。非手术组中除 2 例外，所有患者均采用内镜下纤维蛋白胶注射（EIFS）治疗。在腹腔镜 RYGB 组的 4 例漏中，2 例经 EIFS 治疗后 1 次闭合；然而，修正组的所有漏均需要>1 次 EIFS 治疗。手术组的平均住院时间为 36±34 天，EIFS 患者为 33±7 天。在任何患者中均无需进行 EIFS 治疗失败的手术。
EIFS 为减重手术后发生胃漏的患者提供了安全且成功的治疗方法。我们建议对所有可安全进行非手术治疗的内镜可及性漏患者进行 EIFS。
