Rebibo Lionel, Bartoli Eric, Dhahri Abdennaceur, Cosse Cyril, Robert Brice, Brazier Franck, Pequignot Aurélien, Hakim Sami, Yzet Thierry, Delcenserie Richard, Dupont Hervé, Regimbeau Jean-Marc
Department of Digestive Surgery, Amiens University Hospital, Amiens, France.
Department of Gastroenterology, Amiens University Hospital, Amiens, France.
Surg Obes Relat Dis. 2016 Jan;12(1):84-93. doi: 10.1016/j.soard.2015.04.012. Epub 2015 Apr 24.
Gastric leak (GL) represents one of the main early-onset postoperative complication of sleeve gastrectomy (SG). Most studies of GL featured short series and no data on the time to reoperation for persistent GL.
Characterize the time between discovery of persistent post-SG GL and the implementation of reoperation.
University hospital, France, public practice.
All patients treated for post-SG GL between November 2004 and December 2013 were included. The primary efficacy criterion was the time interval between discovery of a persistent GL and reoperation. The secondary efficacy criteria were demographic, surgical, and endoscopic data; mortality rate; time to GL healing; treatment success rate; and risk factors for failure treatment.
Eighty-six patients were treated for post-SG GL. Forty patients (46.5%) had early-onset GL (postoperative day ≤ 7). Two patients (2.3%) presented primary gastrobronchial fistula. Fifty-six patients (70%) underwent immediate reoperation. Endoscopic treatment was required to treat the GL in 92.7% of the cases (n = 77). The mortality rate was 1.2% (n = 1). The treatment success rate was 89.1%. The median time to healing GL was 84 days (14-423 d). Eighty percent of the GLs had healed 120 days after discovery. After 120 days, the incidence of complications related to GL increased and few additional GLs healed. The only identified risk factor for treatment failure was large retained gastric fundus (P ≤ .05).
Most cases of GL can be adequately treated by incorporating endoscopic stenting. Surgery for persistent GL should be performed within 120 days of discovery; after this cut-off, the incidence of GL-related complications increases. Large retained gastric fundus is a risk factor for treatment failure and may prompt the surgeon to consider earlier reoperation.
胃漏（GL）是袖状胃切除术（SG）主要的早期术后并发症之一。大多数关于胃漏的研究样本量小，且没有关于持续性胃漏再次手术时间的数据。
明确持续性SG后胃漏发现与再次手术实施之间的时间。
法国大学医院，公共医疗实践。
纳入2004年11月至2013年12月期间因SG后胃漏接受治疗的所有患者。主要疗效标准是持续性胃漏发现与再次手术之间的时间间隔。次要疗效标准包括人口统计学、手术和内镜数据；死亡率；胃漏愈合时间；治疗成功率；以及治疗失败的危险因素。
86例患者因SG后胃漏接受治疗。40例患者（46.5%）发生早期胃漏（术后第7天及以内）。2例患者（2.3%）出现原发性胃支气管瘘。56例患者（70%）接受了即刻再次手术。92.7%的病例（n = 77）需要内镜治疗来处理胃漏。死亡率为1.2%（n = 1）。治疗成功率为89.1%。胃漏愈合的中位时间为84天（14 - 423天）。80%的胃漏在发现后120天内愈合。120天后，与胃漏相关的并发症发生率增加，很少有额外的胃漏愈合。唯一确定的治疗失败危险因素是保留的胃底较大（P≤0.05）。
大多数胃漏病例可通过内镜支架置入得到充分治疗。持续性胃漏的手术应在发现后120天内进行；在此时间节点之后，胃漏相关并发症的发生率会增加。保留的胃底较大是治疗失败的危险因素，可能促使外科医生考虑更早进行再次手术。
