van Rutte Pim W J, Naagen Bertus J, Spek Marinus, Jakimowicz Jack J, Nienhuijs Simon W
Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
Faculty of Industrial Design, Technical University of Delft, Delft, The Netherlands.
Surg Technol Int. 2015 Nov;27:123-8.
The sleeve gastrectomy has been accepted as a primary bariatric procedure. One of the most feared complications is staple line leakage. It is important to use the right staple sizes to minimize the risk of leak. Knowledge of gastric thickness is important. The goal of this study was to measure the thickness of the gastric wall after elimination of the gastric folds in the mucosa. An electronic thickness gauge was developed that measured the anterior and posterior wall of the fresh stomach specimen together at 5 points at a pressure based on the finger pressure necessary to flatten the gastric folds. Thirty-three fresh specimens were measured. The mean compression pressure was 714 grams, and no difference was found between the 5 measure points. There was a significant difference in stomach wall thickness. The gastric antrum was more than 1 mm thicker than the fundus. No difference was found between BMI groups <40 Kg/m2, 40-50 Kg/m2, or >50 Kg/m2. No bleeding occurred, leakage occurred in 1 case. There is a significant difference in thickness of the stomach wall between the gastric fundus and the antrum. A pressure 2.5 times lower than applied in prior studies was necessary to achieve full tissue compression. Choosing thinner staple sizes for the gastric fundus might be the optimal technique for compression. However, there are several additional factors that influence the risk of staple line leaks.
袖状胃切除术已被公认为主要的减肥手术。最令人担忧的并发症之一是吻合口漏。使用合适的吻合器尺寸以将漏出风险降至最低很重要。了解胃壁厚度很重要。本研究的目的是测量消除胃黏膜皱襞后胃壁的厚度。开发了一种电子厚度计，基于使胃皱襞变平所需的手指压力，在一定压力下同时测量新鲜胃标本的前壁和后壁的5个点。测量了33个新鲜标本。平均压缩压力为714克，5个测量点之间未发现差异。胃壁厚度存在显著差异。胃窦比胃底厚超过1毫米。体重指数（BMI）<40 Kg/m²、40 - 50 Kg/m²或>50 Kg/m²的组之间未发现差异。未发生出血，1例发生漏出。胃底和胃窦的胃壁厚度存在显著差异。要实现完全组织压缩，所需压力比先前研究中应用的压力低2.5倍。为胃底选择更薄的吻合器尺寸可能是最佳的压缩技术。然而，还有几个其他因素会影响吻合口漏的风险。
