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减重手术的主要并发症:内镜治疗作为一线治疗方法。

Major complications of bariatric surgery: endoscopy as first-line treatment.

机构信息

Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, B-1070, Brussels, Belgium.

出版信息

Nat Rev Gastroenterol Hepatol. 2015 Dec;12(12):701-10. doi: 10.1038/nrgastro.2015.151. Epub 2015 Sep 8.

Abstract

Leaks are the most frequent early postoperative complication in the two most popular bariatric procedures, Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy. Multimodal therapy based on self-expandable stent insertion 'to cover' the defect is the most widely documented technique to date with a reported success rate >80%. Additional experimental techniques 'to close' the defect or 'to drain' the paradigestive cavity have been reported with encouraging results. The role of endoscopy in early postoperative bleeding is limited to management of bleeds arising from fresh sutures and the diagnosis of chronic sources of bleeding such as marginal ulcer after RYGB. Post-RYGB stricture is a more delayed complication than leaks and the role of endoscopic dilation as a first-line treatment in this indication is well documented. Ring and band placement are outdated procedures for obesity treatment, but might still be an indication for endoscopic removal, a technique which does not compromise further surgery, if needed.

摘要

渗漏是两种最流行的减重手术(Roux-en-Y 胃旁路术 [RYGB] 和腹腔镜袖状胃切除术)中最常见的早期术后并发症。基于自膨式支架插入的多模态治疗“覆盖”缺陷是迄今为止最广泛记录的技术,报道的成功率>80%。还有其他实验技术“关闭”缺陷或“引流”消化腔,结果令人鼓舞。内镜在早期术后出血中的作用仅限于处理来自新鲜缝线的出血,以及诊断 RYGB 后的边缘性溃疡等慢性出血源。与渗漏相比,RYGB 后狭窄是一种更迟发的并发症,内镜扩张作为该适应证的一线治疗方法已得到充分证实。环形和带式放置是过时的肥胖治疗方法,但如果需要,内镜切除仍然是一种适应证,这种技术不会影响进一步的手术。

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