Department of Surgery, NYU School of Medicine, New York, NY 10016, USA.
Ann Surg. 2013 Feb;257(2):231-7. doi: 10.1097/SLA.0b013e31826cc714.
To conduct a systematic review to identify surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy (LSG).
LSG is growing in popularity as a primary bariatric procedure. Technical aspects of LSG including bougie size remain controversial.
Our systematic review yielded 112 studies encompassing 9991 LSG patients. A general estimating equation (GEE) model was used to calculate the odds ratio (OR) for leak based on bougie size, distance from the pylorus, and use of buttressing on the staple line. Baseline characteristics, including age and body mass index (BMI), were included. A linear repeated measures regression model compared excess weight loss (%EWL) between bougie sizes.
A total of 198 leaks in 8922 patients (2.2%) were identified. The GEE model revealed that the risk of leak decreased with bougie ≥40 Fr (OR = 0.53, 95% CI = [0.37-0.77]; P = 0.0009). Buttressing did not impact leak. There was no difference in %EWL between bougie <40 Fr and bougie ≥40 Fr up to 36 months (mean: 70.1% EWL; P = 0.273). Distance from the pylorus did not affect leak or %EWL.
Utilizing bougie ≥40 Fr may decrease leak without impacting %EWL up to 3 years. Distance from the pylorus does not impact leak or weight loss. Buttressing does not seem to impact leak; however, if surgeons desire to buttress, bioabsorbable material is the most common type used. Longer-term studies are needed to definitively determine the effect of bougie size on weight loss after LSG.
进行系统评价，以确定可能降低腹腔镜袖状胃切除术（LSG）后漏的手术策略。
LSG 作为一种主要的减肥手术越来越受欢迎。LSG 的技术方面，包括探条大小，仍然存在争议。
我们的系统评价产生了 112 项研究，共包括 9991 例 LSG 患者。使用一般估计方程（GEE）模型，根据探条大小、距幽门的距离以及在吻合线使用支撑物，计算漏的优势比（OR）。纳入了基线特征，包括年龄和体重指数（BMI）。线性重复测量回归模型比较了探条大小之间的超重减轻百分比（%EWL）。
共发现 8922 例患者中有 198 例漏（2.2%）。GEE 模型显示，探条≥40 Fr 时漏的风险降低（OR=0.53，95%CI=[0.37-0.77]；P=0.0009）。支撑物并不影响漏。在 36 个月内，探条<40 Fr 和探条≥40 Fr 之间的%EWL 没有差异（平均：70.1%EWL；P=0.273）。距幽门的距离不影响漏或%EWL。
使用探条≥40 Fr 可能会降低漏的风险，而在 3 年内不会影响%EWL。距幽门的距离不影响漏或减重。支撑物似乎不会影响漏；然而，如果外科医生希望支撑，生物可吸收材料是最常用的类型。需要进行更长时间的研究，以确定探条大小对 LSG 后体重减轻的影响。
