First Department of Propaedeutic Surgery, Hippokration Hospital, Athens Medical School Greece, 114 Queen's Sofia Avenue, Athens, Greece.
Obes Surg. 2014 May;24(5):675-83. doi: 10.1007/s11695-013-1156-z.
Staple line leak, although rare, is among the most common postoperative complications after sleeve gastrectomy (SG) and usually occurs in the gastroesophageal (GE) junction. Increased intragastric pressure, regional ischemia, and technical failure of stapling devices have been reported as the main risk factors of postoperative leak. The aim of this study was to evaluate the impact of ischemia and intraluminal pressure in leak appearance.
Landrace swine (n = 12) were subjected to SG and total gastrectomy subsequently. Lactic acid, glycerol, and pyruvate were measured by microdialysis in GE junction and pylorus before and nine times after operation, and lactate/pyruvate (L/P) ratio was calculated as well. Moreover, ex vivo air was insufflated inside the tubularized stomach till a rupture of the staple line occurs. Maximum air pressure reached and location of rupture were recorded.
Increase of lactic acid and L/P ratio were demonstrated in GE junction measurements; however, when the measurements between GE junction and pylorus were compared, no statistically significant differences were found, with the exception of a slightly increased lactate concentration in pylorus in the midst of measurements. The maximum air pressure recorded varied from 3 to 75 mmHg (mean 24.5 mmHg) and the majority of ruptures (n = 8) occurred in GE junction. In one of them, clip displacement was noticed.
No evidence of increased ischemia in GE junction compared to pylorus was recorded. Increased intraluminal pressure and stapling malfunction may play the most important role in leak appearance.
尽管很少见，但吻合口漏是袖状胃切除术（SG）后最常见的术后并发症之一，通常发生在胃食管（GE）交界处。据报道，胃内压升高、区域性缺血和吻合器技术故障是术后漏的主要危险因素。本研究旨在评估缺血和管腔内压力对漏出的影响。
Landrace 猪（n=12）接受 SG 和全胃切除术。在手术前和手术后 9 次测量 GE 交界处和幽门处的微透析乳酸、甘油和丙酮酸，并计算乳酸/丙酮酸（L/P）比值。此外，将管状胃内的空气吹入管腔，直到吻合线破裂。记录达到的最大空气压力和破裂位置。
GE 交界处的测量结果显示乳酸和 L/P 比值增加；然而，当比较 GE 交界处和幽门处的测量值时，除了测量过程中幽门处乳酸浓度略有升高外，没有发现统计学上的显著差异。记录的最大空气压力从 3 到 75mmHg（平均 24.5mmHg）不等，大多数破裂（n=8）发生在 GE 交界处。其中一个出现了夹钳移位。
与幽门相比，GE 交界处没有发现缺血增加的证据。增加的管腔内压力和吻合器故障可能在漏出中起着最重要的作用。
