Department of Surgery, Hillel Yaffe Medical Center, Hadera, Israel.
Surg Endosc. 2013 Jan;27(1):240-5. doi: 10.1007/s00464-012-2426-x. Epub 2012 Jun 30.
Laparoscopic sleeve gastrectomy (LSG) remains under scrutiny as a stand-alone bariatric procedure. The most feared complication after LSG is staple line leak.
Eight bariatric centers in Israel participated in this study. A retrospective analysis was performed by querying all the LSG cases performed between June 2006 and June 2010. The data collected included patient demographics, anthropometrics, and operative and perioperative parameters.
Among the 2,834 patients who underwent LSG, 44 (1.5%) with gastric leaks were identified. Of these 44 patients, 30 (68%) were women. The patients had a mean age of 41.5 years and a body mass index (BMI) of 45.4 kg/m(2). Intraoperative leak tests and routine postoperative swallow studies were performed with 33 patients, and all but one patient (3%) failed to detect the leaks. Leaks were diagnosed at a median of 7 days postoperatively: early (0-2 days) in nine cases (20%), intermediately (3-14 days) in 32 cases (73%), and late (>14 days) in three cases (7%). For 38 patients (86%), there was clinical suspicion, later confirmed by imaging or operative findings. Computed tomography, swallow studies, and methylene blue tests were performed for 37, 21, and 15 patients, respectively, and the results were positive, respectively, for 31 (84%), 11 (50%), and 9 (60%) of these patients. Reoperation was performed for 27 of the patients (61%). Other treatment methods included percutaneous drainage (n = 28, 63.6%), endoscopic placement of stents (n = 11, 25%), clips (n = 1, 2.3%), and fibrin glue (n = 1, 2.3%). In 33 of the patients (75%), the leak site was found in the upper sleeve near the gastroesophageal junction. The median time to leak closure was 40 days (range, 2-270 days), and the overall leak-related mortality rate was 0.14% (4/2,834).
Gastric leak is the most common cause of major morbidity and mortality after LSG. Routine tests to rule out leaks seem to be superfluous. Rather, selective utilization is recommended. Management options vary, depending mainly on patient disposition. An accepted algorithm for the diagnosis and treatment of gastric leak has yet to be proposed.
腹腔镜袖状胃切除术（LSG）作为一种独立的减重手术仍备受关注。LSG 术后最令人担忧的并发症是吻合口漏。
以色列的 8 家减重中心参与了这项研究。通过查询 2006 年 6 月至 2010 年 6 月期间进行的所有 LSG 病例，进行回顾性分析。收集的数据包括患者人口统计学、人体测量学以及手术和围手术期参数。
在 2834 例行 LSG 的患者中，发现 44 例（1.5%）存在胃漏。这 44 例患者中，30 例（68%）为女性。患者平均年龄为 41.5 岁，体重指数（BMI）为 45.4kg/m²。对 33 例患者进行了术中漏检试验和常规术后吞咽研究，但除 1 例患者（3%）外，所有患者均未检测到漏检。漏诊发生在术后中位数 7 天：9 例（20%）为早期（0-2 天），32 例（73%）为中期（3-14 天），3 例（7%）为晚期（>14 天）。对于 38 例（86%）患者，存在临床怀疑，随后通过影像学或手术发现证实。对 37 例、21 例和 15 例患者分别进行了计算机断层扫描、吞咽研究和亚甲蓝试验，这些患者的结果分别为 31 例（84%）、11 例（50%）和 9 例（60%）阳性。对 27 例患者（61%）进行了再次手术。其他治疗方法包括经皮引流（n=28，63.6%）、内镜支架放置（n=11，25%）、夹闭（n=1，2.3%）和纤维蛋白胶（n=1，2.3%）。在 33 例（75%）患者中，漏口位于胃食管交界处附近的袖状胃上段。漏口闭合的中位时间为 40 天（范围，2-270 天），总体漏相关死亡率为 0.14%（4/2834）。
胃漏是 LSG 术后导致主要发病率和死亡率的最常见原因。排除漏检的常规检查似乎是多余的。相反，建议选择性使用。治疗方法多种多样，主要取决于患者的情况。尚未提出胃漏的诊断和治疗的公认算法。
