Szewczyk Tomasz, Janczak Przemyslaw, Janiak Adam, Gaszyński Tomasz, Modzelewski Bogdan
Department of Gastroenterology, Oncology and General Surgery, Medical University of Lodz, Lodz, Poland.
Department of Emergency and Disaster Medicine, Medical University of Lodz, Lodz, Poland.
Wideochir Inne Tech Maloinwazyjne. 2014 Sep;9(3):427-35. doi: 10.5114/wiitm.2014.44167. Epub 2014 Jul 23.
Laparoscopic sleeve gastrectomy is a procedure frequently chosen by patients and surgeons that carries the risk of serious complications that are difficult to treat.
To describe the operations performed by us, considering complications and their management.
We performed 565 laparoscopic sleeve gastrectomies. Standard surgical technique was used. A 34 Fr calibration tube was used. An additional reinforcing suture was applied over the staple line.
There was no need for conversion. In 7.79% of patients, infarcts of the posterior pole of the spleen were observed, whereas 8 patients (1.42%) developed gastric fistulas in the His angle region. In 3 cases, it led to development of an abscess in the posterior splenic pole region and 2 of these developed secondary gastric fistulas of typical location. In total, there were 5 deaths among the patients who had been operated on - 3 due to septic complications in the course of fistula, 1 due to encephalopathy and 1 as a result of myocardial infarction.
Sleeve gastrectomy is an effective and safe method of obesity treatment. The causes of the most severe complication - gastric fistula - cannot be established unequivocally. Infarcts of the posterior pole of the spleen, as a potential cause of fistulas, deserve particular attention. In our opinion, primary closure of the fistula by suturing is an inappropriate method of management, whereas the best results are obtained with temporary gastrointestinal tract prosthesis.
腹腔镜袖状胃切除术是患者和外科医生常选择的一种手术，但存在难以治疗的严重并发症风险。
描述我们所进行的手术，考虑并发症及其处理方法。
我们进行了565例腹腔镜袖状胃切除术。采用标准手术技术。使用了一根34F的校准管。在吻合钉线处加缝了一根加固缝线。
无需中转开腹。7.79%的患者观察到脾后极梗死，而8例患者（1.42%）在His角区域发生胃瘘。3例导致脾后极区域脓肿形成，其中2例发展为典型部位的继发性胃瘘。在接受手术的患者中共有5例死亡——3例因瘘管过程中的感染性并发症死亡，1例因脑病死亡，1例因心肌梗死死亡。
袖状胃切除术是一种有效且安全的肥胖治疗方法。最严重并发症——胃瘘的病因尚不能明确确定。脾后极梗死作为瘘管的潜在原因值得特别关注。我们认为，通过缝合进行瘘管的一期闭合是一种不恰当的处理方法，而采用临时性胃肠道假体可获得最佳效果。
