Abou Rached Antoine, Basile Melkart, El Masri Hicham
Antoine Abou Rached, Department of Internal Medicine, Gastroenterology Division, Lebanese University, Hadath, Beirut 2903 1308, Lebanon.
World J Gastroenterol. 2014 Oct 14;20(38):13904-10. doi: 10.3748/wjg.v20.i38.13904.
Gastric sleeve gastrectomy has become a frequent bariatric procedure. Its apparent simplicity hides a number of serious, sometimes fatal, complications. This is more important in the absence of an internationally adopted algorithm for the management of the leaks complicating this operation. The debates exist even regarding the definition of a leak, with several classification systems that can be used to predict the cause of the leak, and also to determine the treatment plan. Causes of leak are classified as mechanical, technical and ischemic causes. After defining the possible causes, authors went into suggesting a number of preventive measures to decrease the leak rate, including gentle handling of tissues, staple line reinforcement, larger bougie size and routine use of methylene blue test per operatively. In our review, we noticed that the most important clinical sign or symptom in patients with gastric leaks are fever and tachycardia, which mandate the use of an abdominal computed tomography, associated with an upper gastrointrstinal series and/or gastroscopy if no leak was detected. After diagnosis, the management of leak depends mainly on the clinical condition of the patient and the onset time of leak. It varies between prompt surgical intervention in unstable patients and conservative management in stable ones in whom leaks present lately. The management options include also endoscopic interventions with closure techniques or more commonly exclusion techniques with an endoprosthesis. The aim of this review was to highlight the causes and thus the prevention modalities and find a standardized algorithm to deal with gastric leaks post sleeve gastrectomy.
胃袖状切除术已成为一种常见的减肥手术。其表面上的简单性掩盖了一些严重的、有时甚至是致命的并发症。在缺乏国际通用的处理该手术相关渗漏管理算法的情况下，这一点更为重要。甚至在渗漏的定义方面也存在争议，有几种分类系统可用于预测渗漏的原因，并确定治疗方案。渗漏原因分为机械性、技术性和缺血性原因。在确定了可能的原因之后，作者提出了一些预防措施以降低渗漏率，包括轻柔处理组织、加强吻合钉线、使用更大尺寸的探条以及术中常规使用亚甲蓝试验。在我们的综述中，我们注意到胃渗漏患者最重要的临床体征或症状是发热和心动过速，这就需要进行腹部计算机断层扫描，如果未检测到渗漏，则需结合上消化道造影和/或胃镜检查。诊断后，渗漏的处理主要取决于患者的临床状况和渗漏发生的时间。对于不稳定患者，处理方式可能是立即进行手术干预；对于渗漏出现较晚的稳定患者，则采取保守治疗。处理选项还包括采用闭合技术的内镜干预，或者更常见的是使用内置假体的旷置技术。本综述的目的是强调渗漏的原因以及相应的预防方式，并找到一种标准化的算法来处理胃袖状切除术后的胃渗漏。
