Tan Michael H L, Yee Gary Y W, Jorgensen John O, Kuzinkovas Vytauras, Talbot Michael L, Loi Ken W, Viswanathan Seethalakshmi, Gill Anthony J
Department of Upper GI and Bariatric Surgery, St. George Private Hospital, Sydney, NSW, Australia.
Department of Upper GI and Bariatric Surgery, St. George Private Hospital, Sydney, NSW, Australia.
Surg Obes Relat Dis. 2014 Jul-Aug;10(4):620-5. doi: 10.1016/j.soard.2014.02.037. Epub 2014 Mar 12.
Laparoscopic sleeve gastrectomy (SG) is gaining popularity as a revision option after failed laparoscopic adjustable gastric banding (LAGB). Data have shown that single stage revisions may be associated with a higher complication rate. A histologic basis for this observation has not been studied. The objective of this study was to document the histologic properties of the LAGB capsule across the gastric staple line after SG at various time points after LAGB removal.
Gastric sleeve specimens of all LAGB to SG revisions were identified from January to May 2013 and underwent histologic evaluation of the LAGB capsule. Single blinded pathologist interpretation was performed, with inflammation, fibrosis, neovascularization, foreign body (FB) reaction, and wall thickness assessed semi-quantitatively and scored from 0-3. Based on combined features, an attempt was made to predict the timing of revision surgery.
The study identified 19 revisions performed for inadequate excess weight loss or weight regain. The mean age for revision was 44 (19-65). The minimum time to revision was 42 days, the longest 1,188 days. There were no surgical complications. Varying degrees of inflammation and fibrosis were common features at all times. Angiogenesis, neovascularization and FB reaction were prominent in revisions performed before 80 days. The gastric wall was thicker during early revision. The optimal time to perform revision was difficult to determine.
LAGB caused varying degrees of inflammatory and FB reaction that time did not fully resolve. The lower leak rates observed with delayed revisions do not appear to be attributable to gastric histology.
腹腔镜袖状胃切除术（SG）作为腹腔镜可调节胃束带术（LAGB）失败后的一种翻修选择正逐渐受到欢迎。数据显示，一期翻修可能与更高的并发症发生率相关。尚未对这一观察结果的组织学基础进行研究。本研究的目的是记录在移除LAGB后的不同时间点，SG术后胃吻合线处LAGB包膜的组织学特性。
从2013年1月至5月确定所有LAGB转为SG的胃袖状标本，并对LAGB包膜进行组织学评估。由单盲病理学家进行解读，对炎症、纤维化、新生血管形成、异物（FB）反应和壁厚度进行半定量评估，并从0至3分进行评分。基于综合特征，尝试预测翻修手术的时机。
该研究确定了19例因体重减轻不足或体重反弹而进行的翻修手术。翻修的平均年龄为44岁（19 - 65岁）。最短翻修时间为42天，最长为1188天。无手术并发症。不同程度的炎症和纤维化在所有时间都是常见特征。血管生成、新生血管形成和FB反应在80天前进行的翻修中较为突出。早期翻修时胃壁较厚。难以确定进行翻修的最佳时间。
LAGB引起不同程度的炎症和FB反应，且这种反应不会随时间完全消退。延迟翻修时观察到的较低渗漏率似乎并非归因于胃组织学。
