Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, 91120, Israel.
Obes Surg. 2013 Oct;23(10):1685-91. doi: 10.1007/s11695-013-1047-3.
Laparoscopic sleeve gastrectomy (LSG) has become a common surgical procedure, yet there is no consensus on what bougie size is best for LSG. We reviewed the literature and assessed the relationship between the size of bougie used and the incidence of leak as well as weight loss parameters. We wanted to determine if there is an ideal bougie size for LSG. A search of the medical literature was undertaken. We limited the search to articles published in the last 5 years written in English and investigating humans. We analyzed 32 publications comprising 4,999 patients. We determined the frequency of staple line leaks as well as weight loss parameters in relation to bougie size. This study was exempt from our institutional review board. The use of bougies of 40 French (F) and larger was associated with a leak rate of 0.92% as opposed to 2.67% for smaller bougies (p < 0.05). Weight loss in percent of extra weight loss (%EWL) was 69.2% when a bougie of 40 F and larger was used, as opposed to 60.7% of EWL when smaller bougies were used (p = 0.29). LSG is becoming an important and common procedure. Larger sizing bougies are associated with a significant decrease in incidence of leak with no change in weight loss. Further studies are needed before an unequivocal decision on the optimal bougie size is made. A recommendation to use the smallest bougie possible should be avoided because the risks may outweigh the benefits.
腹腔镜袖状胃切除术（LSG）已成为一种常见的手术方法，但对于 LSG 最合适的球囊尺寸尚无共识。我们复习了文献，并评估了使用的球囊尺寸与漏诊率以及减重参数之间的关系。我们想确定 LSG 是否存在理想的球囊尺寸。对医学文献进行了检索。我们将搜索范围限制在过去 5 年内以英文发表并针对人类进行研究的文章。我们分析了 32 篇包含 4999 例患者的出版物。我们确定了与球囊尺寸相关的吻合口漏诊率和减重参数。这项研究获得了我们机构审查委员会的豁免。使用 40 法国（F）及以上尺寸的球囊与 0.92%的漏诊率相关，而使用较小尺寸的球囊则漏诊率为 2.67%（p<0.05）。使用 40 F 及以上尺寸的球囊时，体重减轻率为额外体重减轻的 69.2%，而使用较小尺寸的球囊时体重减轻率为额外体重减轻的 60.7%（p=0.29）。LSG 正成为一种重要且常见的手术。较大尺寸的球囊与漏诊率显著降低相关，而体重减轻率无变化。在做出关于最佳球囊尺寸的明确决定之前，还需要进一步的研究。建议避免使用最小的球囊，因为风险可能大于收益。
