Rebibo Lionel, Dhahri Abdennaceur, Verhaeghe Pierre, Regimbeau Jean-Marc
Department of Digestive Surgery, Amiens University Hospital and Jules Verne University of Picardie, Place Victor Pauchet, 80054, Amiens cedex 01, France.
Obes Surg. 2014 Dec;24(12):2069-74. doi: 10.1007/s11695-014-1320-0.
Laparoscopic sleeve gastrectomy (LSG) is increasingly popular with surgeons because of its apparent technical ease. However, performing LSG safely is sometimes not possible during laparoscopy. The objectives of the present study were to (i) describe the context of LSG failure and (ii) suggest preoperative care options or strategies that enable secondary LSG to be performed safely.
We studied patients having undergone primary and secondary LSG between January 2008 and July 2013. The primary efficacy criterion was the LSG success rate. The secondary efficacy criteria were preoperative care procedures, the complication rate, the failure rate, and the frequency of conversion to open surgery.
During the study period, 954 patients underwent first- or second-line LSG. Laparoscopic sleeve gastrectomy was technically impossible in 12 patients (1.2 %). The cause of failure was a large left liver lobe in seven cases (58.3 %) and a lack of space in five cases. Of these 12 patients, nine underwent secondary LSG. The median preoperative BMI before the first LSG was 51.5 kg/m(2). The median (range) time interval between the two LSG attempts was 6 months (3-37). Prior to secondary LSG, the preoperative weight reduction measure was a diet in seven cases (78 %), an intragastric balloon in one case, and no treatment in one case. The median preoperative excess weight loss (EWL) before the second LSG was 10 % (0-20). Five LSGs were successful, two required conversion to open surgery, and two failed again. There were two postoperative complications (22 %), both of which concerned the two patients with conversion to laparotomy.
In the event of LSG technical failure, preoperative weight loss may enable a second attempt at laparoscopic treatment. A preoperative EWL of at least 10 % appears to be required for the avoidance of conversion to laparotomy.
腹腔镜袖状胃切除术（LSG）因其操作技术相对简单，越来越受外科医生欢迎。然而，在腹腔镜手术过程中，有时无法安全地实施LSG。本研究的目的是：（i）描述LSG失败的情况；（ii）提出术前护理方案或策略，以使二次LSG能够安全进行。
我们研究了2008年1月至2013年7月期间接受初次和二次LSG的患者。主要疗效标准是LSG成功率。次要疗效标准是术前护理程序、并发症发生率、失败率以及转为开放手术的频率。
在研究期间，954例患者接受了一线或二线LSG。12例患者（1.2%）在技术上无法进行腹腔镜袖状胃切除术。失败原因是左肝叶较大7例（58.3%），以及5例空间不足。这12例患者中，9例接受了二次LSG。初次LSG前的术前中位体重指数为51.5kg/m²。两次LSG尝试之间的中位（范围）时间间隔为6个月（3 - 37个月）。在二次LSG之前，术前减重措施为7例（78%）采用节食，1例采用胃内球囊，1例未进行治疗。二次LSG前的术前中位超重减轻（EWL）为10%（0 - 20）。5例LSG成功，2例需要转为开放手术，2例再次失败。有2例术后并发症（22%），均与转为剖腹手术的2例患者有关。
如果LSG技术失败，术前减重可能使腹腔镜治疗得以再次尝试。为避免转为剖腹手术，术前EWL似乎至少需要达到10%。
