Department of Surgery, HGZ 35, Mexican Institute of Social Security, C. Valentín Fuentes 2582, 32600, Juarez, Chihuahua, Mexico,
Surg Endosc. 2013 Dec;27(12):4721-30. doi: 10.1007/s00464-013-3123-0. Epub 2013 Aug 16.
Laparoscopic sleeve gastrectomy (LSG) consists of a longitudinal resection of the stomach on the greater curvature, removing 75-80% of the stomach approximately and creating a cylindrical "sleeve"-like conduit. However, LSG can be associated with significant morbidity, and staple-line failure with dehiscence and gastric leak is one of the most severe complications. The aim of this study was to compare three different methods of gastric closure in terms of staple-line strength and leak pressures of the sleeved stomach.
After performing standard stapled sleeve gastrectomies, the gastric specimens were carefully retrieved. Group 1 specimens were left with the staple line intact. In group 2, the staple line was reinforced with a 3-0 polypropylene running suture. The gastric remnants of group 3 were those in which the LSG was performed using Seamguard as the buttressing material. The burst-pressure was assessed using a portable gas sensor. The outcome parameters were: age of the patients, body mass index, buttress material (suture, Seamguard, etc.), leak pressure, volume infused, and leak site, among others.
Thirty-six sleeve gastrectomies were included in the final analysis. Each group consisted of 12 gastric specimens. There were no differences between groups in terms of age, sex, body mass index, and patient comorbidities. The leak pressure was significantly higher in group 2 (35 ± 11.7 vs. 102 ± 21.4 vs. 47 ± 19.1; p = <0.0005). The volume of liquid required to cause the leak was much greater in the group 3 (p = <0.001).
Oversewing is the reinforcement method that increases better the staple-line strength. It is the least expensive method of reinforcement and does not increase operative times significantly.
腹腔镜袖状胃切除术（LSG）由胃大弯的胃壁进行纵向切除，切除胃的 75-80%，形成一个圆柱形的“袖套”样管道。然而，LSG 可能会导致严重的发病率，并且缝线线结失败导致裂开和胃漏是最严重的并发症之一。本研究的目的是比较三种不同的胃闭合方法在缝线线结强度和套状胃漏压方面的效果。
在进行标准的吻合胃袖状胃切除术后，仔细取出胃标本。第 1 组标本保留缝线线结完整。第 2 组用 3-0 聚丙烯连续缝线加固缝线线结。第 3 组的胃残端是使用 Seamguard 作为支撑材料进行 LSG 的。使用便携式气体传感器评估破裂压力。观察指标包括：患者年龄、体重指数、支撑材料（缝线、Seamguard 等）、漏压、注入量和漏点等。
最终分析纳入 36 例袖状胃切除术。每组包含 12 个胃标本。三组间在年龄、性别、体重指数和患者合并症方面无差异。第 2 组的漏压明显更高（35 ± 11.7 比 102 ± 21.4 比 47 ± 19.1；p <0.0005）。第 3 组导致漏液所需的液体量明显更大（p <0.001）。
缝合加固是一种能够更好地增加缝线线结强度的方法。它是最经济的加固方法，并且不会显著增加手术时间。
