Department of Surgery A, Soroka University Medical Center, Ben-Gurion University of the Negev, POB 151, Beer-Sheva, 84101, Israel.
Obes Surg. 2012 Dec;22(12):1893-6. doi: 10.1007/s11695-012-0768-z.
Gastric perforations are one of the intraoperative complications of laparoscopic gastric banding (LAGB). Delayed diagnosis can increase the mortality and morbidity rates.
Retrospective analysis of surgery outcome and long-term follow-up of the patients with gastric perforations during primary LAGB and revisional band procedures was performed.
Twenty-four patients with gastric perforations were identified during 15 years of LAGB surgeries. Half of these had primary LAGB and half had revisional procedures (five emergent and seven elective). Gastric tear was found at surgery in 19 patients; the band was preserved and LAGB was completed in 18 of these. Five patients had delayed diagnosis and underwent re-exploration 24-72 h after surgery. During the surgery, 23 anterior, 8 posterior, 1 esophageal, and 1 small bowel tears were found. Laparoscopic repair was successful in 19 (83%) cases. The mean surgery time and mean hospital stay were 56.3 min and 7.8 days, respectively. Morbidity and mortality rates were 25 and 4.1%, respectively. Two patients underwent later band replacement following removal. Band erosion was observed in one patient. At least 17 patients had no complications during mean follow-up of 52.2 months.
Band preservation is recommended following primary repair of gastric tear. Early intra- and postoperative diagnosis of gastric tear in LAGB is essential for successful management of this iatrogenic injury and decreases occurrence of complications.
胃穿孔是腹腔镜胃束带术（LAGB）术中的并发症之一。延迟诊断会增加死亡率和发病率。
对原发性 LAGB 和再手术中胃穿孔患者的手术结果和长期随访进行回顾性分析。
在 15 年的 LAGB 手术中，发现 24 例胃穿孔患者。其中一半为原发性 LAGB，一半为再手术（急诊 5 例，择期 7 例）。19 例患者术中发现胃撕裂，保留胃束带，其中 18 例完成 LAGB。5 例患者延迟诊断，术后 24-72 小时再次手术。术中发现 23 例前壁、8 例后壁、1 例食管和 1 例小肠撕裂。19 例（83%）腹腔镜修复成功。手术时间和住院时间的平均值分别为 56.3 分钟和 7.8 天。发病率和死亡率分别为 25%和 4.1%。2 例患者在移除后行后期带更换。1 例患者观察到带侵蚀。至少 17 例患者在平均 52.2 个月的随访中无并发症。
建议在胃撕裂的初次修复后保留束带。LAGB 中胃撕裂的早期术中及术后诊断对于成功处理这种医源性损伤并减少并发症的发生至关重要。
