第四届国际袖状胃切除术共识峰会关于腹腔镜袖状胃切除术（LSG）的调查。
Survey on laparoscopic sleeve gastrectomy (LSG) at the Fourth International Consensus Summit on Sleeve Gastrectomy.
机构信息
Clinical Professor of Surgery, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA,
出版信息
Obes Surg. 2013 Dec;23(12):2013-7. doi: 10.1007/s11695-013-1040-x.
BACKGROUND
LSG has been increasingly performed. Long-term follow-up is necessary.
METHODS
During the Fourth International Consensus Summit on LSG in New York Dec. 2012, an online questionnaire (SurveyMonkey®) was filled out by 130 surgeons experienced in LSG. The survey was submitted directly to the statisticians.
RESULTS
The 130 surgeons performed 354.9 ± SD 453 LSGs/surgeon (median 175), for a total of 46,133 LSGs. The LSGs had been performed over 4.9 ± 2.7 year (range 1-10). Of the 46,133 LSGs, 0.2 ± 1.0 % (median 0, range 0-10 %) were converted to an open operation. LSG was intended as the sole operation in 93.1 ± 14.8 %; in 3.0 ± 6.3 %, a second stage became necessary. Of the 130 surgeons, 40 (32 %) use a 36F bougie, which was most common (range 32-50F). Staple-line is reinforced by 79 %; of these, 57 % use a buttress and 43 % over-sew. Mean %EWL at year 1 was 59.3 %; year 2, 59.0 %; year 3, 54.7 %; year 4, 52.3 %; year 5, 52.4 %; and year 6, 50.6 %. If a second-stage operation becomes necessary, preference was: RYGB 46 %, duodenal switch 24 %, re-sleeve 20 %, single-anastomosis duodenoileal bypass 3 %, sleeve plication 3 %, minigastric bypass 3 %, non-adjustable band 2 %, and side-to-side jejunoileal anastomosis 1 %. Complications were: high leak 1.1 %, hemorrhage 1.8 %, and stenosis at lower sleeve 0.9 %. Postoperative gastroesophageal reflux occurred in 7.9 ± 8.2 % but was variable (0-30 %). Mortality was 0.33 ± 1.6 %, which translates to ≈ 152 deaths. Eighty-nine percent order multivitamins (including vitamin D, calcium, and iron) and 72 % order B12. A PPI is ordered by 29 % for 1 month, 29 % for 3 months, and others for 1-12 months depending on the case.
CONCLUSIONS
LSG was relatively safe. Further long-term surveillance is necessary.
背景
LSG 手术的应用越来越广泛，需要进行长期随访。
方法
在 2012 年 12 月于纽约举行的第四届 LSG 国际共识峰会上，130 名经验丰富的 LSG 外科医生在线填写了一份问卷（SurveyMonkey®）。调查结果直接提交给了统计人员。
结果
这 130 名外科医生共完成了 354.9 ± SD 453 例 LSG/外科医生（中位数为 175 例），总计 46,133 例 LSG 手术。这些手术的开展时间为 4.9 ± 2.7 年（范围为 1-10 年）。在这 46,133 例 LSG 手术中，0.2 ± 1.0%（中位数为 0，范围为 0-10%）转为开放性手术。93.1 ± 14.8%的手术旨在作为单一手术；3.0 ± 6.3%的手术需要进行第二阶段手术。在这 130 名外科医生中，40 名（32%）使用 36F 扩张器，这是最常用的（范围为 32-50F）。79%的外科医生对吻合口进行加固；其中 57%使用支撑物，43%进行缝合加固。第 1 年的平均 EWL 为 59.3%；第 2 年为 59.0%；第 3 年为 54.7%；第 4 年为 52.3%；第 5 年为 52.4%；第 6 年为 50.6%。如果需要进行第二阶段手术，首选方案为：RYGB 46%、十二指肠转流术 24%、再次袖状胃切除术 20%、单吻合口十二指肠空肠旁路术 3%、袖状胃折叠术 3%、迷你胃旁路术 3%、不可调节带 2%、侧侧空肠空肠吻合术 1%。并发症包括：高漏率 1.1%、出血 1.8%和下段袖状胃狭窄率 0.9%。术后胃食管反流发生率为 7.9 ± 8.2%，但存在差异（0-30%）。死亡率为 0.33 ± 1.6%，相当于约 152 例死亡。89%的医生会开多种维生素（包括维生素 D、钙和铁），72%的医生会开维生素 B12。29%的医生会开具质子泵抑制剂（PPI），使用时间为 1 个月，29%的医生开具 3 个月，其他医生根据具体情况开具 1-12 个月。
结论
LSG 手术相对安全，但仍需进行长期随访。
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