Noel Patrick, Nedelcu Marius, Gagner Michel
Hôpital Prive La Casamance, Aubagne, France.
Digestive and Endocrine Surgery, University Hospital of Strasbourg, 1, Place de l'Hôpital, 67091, Strasbourg, France.
Obes Surg. 2016 Aug;26(8):1782-7. doi: 10.1007/s11695-015-2003-1.
Laparoscopic sleeve gastrectomy (LSG) has become one of the most commonly performed bariatric procedures, largely due to several advantages it carries over more complex bariatric procedures. LSG is generally considered a straightforward procedure, but one of the major concerns is a staple line leak.
The objectives of this study are to evaluate the correlation between surgeon's experience and leak rate and to assess the different risk factors for developing a gastric leak after LSG.
Private hospital, France.
The analysis of a single surgeon's yearly leak rate since the introduction of LSG for possible risk factors was done.
A total of 2012 LSGs were performed in between September, 2005 and December, 2014. Twenty cases (1 %) of gastric leak were recorded. Of these, 17 patients were women (94.4 %) with a mean age of 39.4 years (range 22-61) and mean body mass index (BMI) 41.2 kg/m(2) (range 34.8-57.1). On a yearly basis, the leak rate was 4.8 % (2006), 5.7 % (2007), 0 (2008), 2.6 % (2009), 2 % (2010), 0.8 % (2011), 0.6 % (2012), 0.2 % (2013), and 0 (2014). In the first 1000 cases (group A), there were 18 cases of gastric leak and in the last 1000 cases, there were 800 with GORE® SEAMGUARD® Bioabsorbable Staple Line Reinforcement (group B) 2 cases of gastric leak (p = 0.009). A revisional LSG, 395 patients after gastric banding and 61 patients re-sleeve gastrectomy, was performed in 456 cases (22.7 %). There were 3 cases of leak (0.65 %). There were two deaths.
LSG can be performed with a low complication rate. This large series of a single surgeon's experience demonstrated that the leak rate after LSG could be significantly decreased over time with changes in techniques.
腹腔镜袖状胃切除术（LSG）已成为最常用的减肥手术之一，这主要归功于它相较于更复杂的减肥手术所具有的诸多优势。LSG一般被认为是一种简单直接的手术，但主要问题之一是吻合钉线漏。
本研究的目的是评估外科医生经验与漏率之间的相关性，并评估LSG术后发生胃漏的不同风险因素。
法国私立医院。
对自开展LSG以来单一外科医生每年的漏率进行分析，以寻找可能的风险因素。
2005年9月至2014年12月期间共进行了2012例LSG手术。记录到20例（1%）胃漏病例。其中，17例患者为女性（94.4%），平均年龄39.4岁（范围22 - 61岁），平均体重指数（BMI）为41.2kg/m²（范围34.8 - 57.1）。按年份来看，漏率分别为4.8%（2006年）、5.7%（2007年）、0（2008年）、2.6%（2009年）、2%（2010年）、0.8%（2011年）、0.6%（2012年）、0.2%（2013年）和0（2014年）。在前1000例病例（A组）中，有18例胃漏；在最后1000例病例中，800例使用了戈尔® SEAMGUARD® 生物可吸收吻合钉线加固材料（B组），有2例胃漏（p = 0.009）。456例（22.7%）患者进行了翻修性LSG，其中395例为胃束带术后患者，61例为再次袖状胃切除术患者。有3例漏（0.65%）。有2例死亡。
LSG手术并发症发生率较低。这一基于单一外科医生大量经验的研究表明，随着技术的改进，LSG术后的漏率会随时间显著降低。
