Department of Bariatric Surgery, AZ Sint Blasius Medical Center, Dendermonde, Belgium.
Surg Obes Relat Dis. 2013 Nov-Dec;9(6):856-61. doi: 10.1016/j.soard.2013.01.003. Epub 2013 Jan 16.
Laparoscopic sleeve gastrectomy (LSG) is an increasingly popular bariatric procedure. However, after LSG, leaks may occur that are difficult to treat and that can persist for months. Treatment is controversial and ranges from stent placement to total gastrectomy. We propose an alternative laparoscopic treatment. The aims of our study were to report on the incidence of chronic fistulas after LSG and the outcome of Roux-limb placement on these defects. The setting was a major teaching hospital in Belgium.
From January 1, 2002, to December 31, 2011, we performed LSG as a primary weight loss operation (PLSG) in 728 patients and as a corrective operation (CLSG) in 84 patients. A retrospective chart and database review was conducted. When a chronic leak persisted beyond 4 months, we performed a laparoscopic Roux-limb placement on the defect.
Leaks occurred in 26 patients (3.6%) after PLSG and in 6 (7.1%) after CLSG. A leak persisted beyond 4 months in 7 patients (26.9%) after PLSG and in 2 patients (33.3%) after CLSG. Two patients with a chronic fistula after PLSG were referred to our hospital. In 11 patients, a Roux limb was laparoscopically sutured to the defect. The mean time for a chronic fistula to heal after Roux-limb placement was 12.5±10.2 days, and the mean length of hospital stay was 19.6± 14.2.
Proximal leaks after LSG are relatively rare. However, a significant number become chronic. Laparoscopic placement of a Roux-limb on the defect is a safe treatment with an eventual succes rate of 100%.
腹腔镜袖状胃切除术（LSG）是一种日益流行的减重手术。然而，LSG 后可能会发生难以治疗且持续数月的漏诊。治疗方法存在争议，范围从支架放置到全胃切除术。我们提出了一种替代的腹腔镜治疗方法。我们的研究目的是报告 LSG 后慢性瘘的发生率以及 Roux 支放置治疗这些缺陷的结果。该研究在比利时的一家主要教学医院进行。
从 2002 年 1 月 1 日至 2011 年 12 月 31 日，我们对 728 例患者进行了 LSG 作为原发性减重手术（PLSG），对 84 例患者进行了作为纠正性手术（CLSG）。对病历和数据库进行了回顾性分析。当慢性漏持续超过 4 个月时，我们对缺陷部位进行腹腔镜 Roux 支放置。
PLSG 后有 26 例（3.6%）和 CLSG 后有 6 例（7.1%）发生漏诊。PLSG 后有 7 例（26.9%）和 CLSG 后有 2 例（33.3%）慢性漏持续超过 4 个月。PLSG 后有 2 例慢性瘘患者被转至我院。11 例患者通过腹腔镜将 Roux 支缝合到缺陷部位。Roux 支放置后慢性瘘愈合的平均时间为 12.5±10.2 天，平均住院时间为 19.6±14.2 天。
LSG 后近端漏诊相对少见。然而，有相当一部分会发展为慢性瘘。腹腔镜 Roux 支放置治疗缺陷是一种安全的治疗方法，最终成功率为 100%。
